記述言語：日本語   出版者・発行元：Taiwanese Journal of Obstetrics and Gynecology  

Objective: Niraparib (NIRA) is a poly(ADP-ribose) polymerase inhibitor used as maintenance therapy for ovarian carcinomas. Thrombocytopenia is a common adverse event associated with NIRA. This study aimed to evaluate the frequency of NIRA-induced thrombocytopenia and the associated risk factors in clinical practice. Materials and methods: Data from 30 patients who received NIRA as a first-line or recurrent treatment at our institution were retrospectively analyzed to assess reductions in platelet count (PLT). Results: The median participant age was 59 (range: 39–75) years, and the median weight was 50 (range: 36–80) kg. NIRA was initiated at a median of 4 (range: 3–8) weeks after the last chemotherapy dose. The prevalence of grade ≥3 thrombocytopenia was 23.3 %, dose interruptions occurred in 53.3 % and dose reductions occurred in 40 %. The median follow-up time was 20 (range: 2–166) months after resumption. Due to thrombocytopenia, one patient discontinued treatment 2 weeks after administration (nadir PLT: 1 × 10⁹/L), and 2 others discontinued treatment after resumption. For the non-interruption and interruption groups, the median nadir PLTs were 194 (91–318) and 57 (1–89) × 10⁹/L (p < 0.001), respectively, the median baseline PLTs were 215 vs. 120 × 10⁹/L (p < 0.001), respectively, and the nadir PLTs during prior chemotherapy were 175 vs. 73 × 10⁹/L (p = 0.007), respectively. Lower baseline PLTs were significantly associated with an increased risk of thrombocytopenia (OR 0.793, 95 % CI 0.654–0.964; p = 0.019). Conclusions: Our real-world data reaffirmed that thrombocytopenia is a significant adverse event that affects the continuation of NIRA and requires careful monitoring. Adjusting the start time to ensure an adequate baseline PLT may help mitigate this risk, but larger-scale studies are needed to validate these findings.

DOI： 10.1016/j.tjog.2025.04.024

Scopus

PubMed

記述言語：日本語   出版者・発行元：Case Reports in Critical Care  

Background: Amniotic fluid embolism can lead to severe complications, including cardiac arrest, a significant cause of maternal mortality. Case Presentation: A 36-year-old woman with postpartum hemorrhage was transported to our hospital. Shortly after her arrival, she experienced cardiac arrest and required immediate extracorporeal life support. A hysterectomy was performed, but persistent bleeding necessitated open abdomen management for damage control to stabilize the patient′s condition. On the second day, she was successfully weaned from extracorporeal membrane oxygenation, followed by catheter removal and complete abdominal closure. The patient was discharged with no neurological sequelae. Pathological examination of the hysterectomy specimen confirmed amniotic fluid embolism. Conclusion: Extracorporeal life support may be effective as a last resort for cardiac arrest due to amniotic fluid embolism, and damage control surgery may be beneficial for managing intractable bleeding.

DOI： 10.1155/crcc/3347972

Scopus

記述言語：日本語   出版者・発行元：Journal of Robotic Surgery  

Robot-assisted surgery has become widely accepted as a minimally invasive approach. However, its safety and feasibility in older women undergoing gynecologic procedures remain insufficiently explored. This retrospective study compared perioperative outcomes between two older age groups and evaluated surgical risks by using the E-PASS and POSSUM scoring systems. A total of 61 women aged ≥ 70 years who underwent robot-assisted gynecologic surgery at our institution were analyzed. Endometrial cancer cases involved hysterectomy with sentinel lymph node biopsy, while procedures for pelvic organ prolapse included sacrocolpopexy with vaginal surgery. The patients were categorized into pre-old (70–74 years) and old (75–89 years) groups. Although prior abdominal surgery was significantly more common in the old group (58.3 vs. 13.5%, p = 0.0003), no significant differences were found in comorbidities, the operative time (242 vs. 235 min), blood loss, or the duration of hospital stay. One pre-old patient developed a pelvic infection (Clavien–Dindo grade IIIa); no other serious complications occurred, and overall complication rates were similar. Two cases of postoperative delirium were not predicted preoperatively. Perioperative risk scores indicated a low risk in both groups. While midterm postoperative outcomes were generally favorable, some patients experienced new health-related events, which were unrelated to surgery. These findings suggest that robotic surgery is feasible and that age alone should not be a contraindication. However, importantly, these outcomes were achieved in a cohort that received comprehensive perioperative care; therefore, further studies with larger cohorts are needed. Moreover, perioperative planning should consider not only physical conditions but also the cognitive and mental status, the living environment, and social support.

DOI： 10.1007/s11701-025-02479-y

Scopus

PubMed

記述言語：日本語   出版者・発行元：Journal of Robotic Surgery  

The effectiveness of cystoscopy in reducing urinary tract complications during robotic gynecologic surgery is poorly documented. Since the introduction of robotic surgery at our institution, cystoscopy has been consistently employed as a standard practice, and its usefulness was investigated. This retrospective study evaluated the utility of routine cystoscopy in patients who underwent robotic surgery between February 2017 and April 2024. The outcome was the detection rate of bladder and ureteral complications. Indigo carmine was injected intravenously while suturing the post-hysterectomy vaginal stump. Light permeation of the bladder wall was visually assessed intra-abdominally. Any leakage of the indigo carmine into the peritoneum or outflow from the external ureteral opening were noted. Eleven of 403 patients were suspected of having urinary tract complications. Among the 11 patients, two exhibited damage to the serous and muscular layers of the bladder, while nine had no outflow from the external ureteral opening. Among these nine cases, one patient was found to have right ureteral obstruction, which was attributed to vaginal stump suturing. The sensitivity and specificity for ureteral obstruction detection were 100% and 98.0%, respectively. In the remaining eight patients, no urinary complications could be identified postoperatively. Overall, the rate of bladder injury was 4/403 (0.9%), all of which were repaired intraoperatively, including two cases found by cystoscopy. Ureteral obstruction was identified in 1/403 (0.2%), and the case was due to intraoperative cystoscopy. Postoperatively, ureteral stenosis was observed in 1/403 (0.2%), and urinary tract infection (cystitis: Grade 2 or less) was noted in 6/403 (1.5%). This technique is an effective diagnostic tool with minimal patient burden and is likely to accurately identify ureteral obstruction or bladder injury during surgery.

DOI： 10.1007/s11701-025-02407-0

Scopus

PubMed

記述言語：日本語   出版者・発行元：Journal of Gynecologic Oncology  

Objective: To evaluate and compare the perioperative and oncologic outcomes of laparoscopic and robotic-assisted surgeries in patients with low-risk endometrial cancer who underwent minimally invasive surgery (MIS) for complete surgical staging, including sentinel lymph node mapping. Methods: A retrospective study included 190 patients diagnosed with low-risk endometrial cancer who underwent MIS combined with sentinel lymph node navigation surgery (SNNS) between December 2016 and December 2021. Among these patients, 66 underwent laparoscopic surgery, while 124 underwent robotic-assisted surgery. The analysis focused on patient characteristics, perioperative outcomes, and prognostic factors, including recurrence-free survival (RFS) and overall survival (OS). Statistical analysis was performed using Kaplan–Meier survival curves and appropriate comparative tests for outcome evaluation. Results: The median operative time and estimated blood loss were significantly longer and greater in the robotic surgery group than in the laparoscopic group (209.5 vs. 157.5 min, 20 vs. 5 mL, respectively). The identification rates of sentinel nodes were 97% and 95.2% in the laparoscopic and robotic groups, respectively, with no significant difference between the 2. Recurrence was observed in two and three cases in the laparoscopic robotic surgery groups, respectively. The 3-year RFS rates were 97.6% (95% confidence interval [CI]=0.8482–0.9769) and 93.9% (95% CI=0.9277–0.9922) for the robotic and laparoscopic groups, respectively, while the 3-year OS rates were 99.2% (95% CI=0.8561–0.9902) and 96.1% (95% CI=0.9450– 0.9989), respectively, with no statistically significant differences. Conclusion: MIS combined with SNNS is a highly effective approach for managing low-risk endometrial cancer, providing comparable oncologic outcomes to laparoscopy while enhancing the quality of life of patients.

DOI： 10.3802/jgo.2025.36.e122

Scopus

PubMed

記述言語：日本語   出版者・発行元：Journal of Obstetrics and Gynaecology Research  

Aim: Trachelectomy is a fertility-preserving surgical approach for early-stage cervical cancer. To enhance oncological safety, intraoperative sentinel lymph node (SN) evaluation has been incorporated. This study aimed to evaluate the long-term oncological and obstetric outcomes of trachelectomy with SN biopsy. Methods: We enrolled 53 patients who underwent trachelectomy with intraoperative SN assessment at Kagoshima University Hospital between 2014 and 2022. The preoperative and intraoperative eligibility criteria were strictly applied. Surgical and obstetric outcomes were evaluated, and recurrence-free survival (RFS) and overall survival (OS) were calculated using the Kaplan–Meier analysis. Results: Among the 78 candidates, 53 met all criteria and successfully underwent trachelectomy. The 5-year RFS and OS rates were both 98%. Bilateral SNs were detected in 98% of patients, and intraoperative SN biopsy-guided surgical decisions were made. Postoperative complications occurred in 6% of the patients. Of the 19 patients who attempted conception, 10 (53%) became pregnant, leading to 8 live births (five preterm, three term). In vitro fertilization and embryo transfer were used in 60% of the pregnancies. Pregnancy was associated with a high risk of preterm delivery. Conclusions: Trachelectomy with intraoperative SN biopsy is a feasible and safe treatment option for appropriately selected patients with early-stage cervical cancer. It offers excellent oncological outcomes and acceptable fertility potential. However, the risk of obstetric complications, particularly preterm births, remains high. Structured postoperative and perinatal management is crucial. Further prospective multicenter studies are warranted to validate and refine this approach.

DOI： 10.1111/jog.70091

Scopus

PubMed

記述言語：英語   出版者・発行元：John Wiley & Sons Australia, Ltd  

妊孕性温存を希望する若年子宮頸癌患者における子宮頸部摘出術と術中センチネルリンパ節(SN)生検の有効性と安全性を評価する目的で、長期的な腫瘍学的・産科アウトカムの後ろ向き解析を行った。2014～2022年に妊孕性温存子宮頸部摘出術を希望した78例に術前・術中の適格基準を厳格に適用し、すべての基準を満たした53例(中央値34歳)に子宮頸部摘出術を施行した。5年無再発生存率、全生存率はともに98%であった。52例(98%)で両側SNが検出可能であった。3例(6%)が術後合併症を発生した。術後に妊娠を試みた19例中10例(53%)が妊娠に至り、8例(80%)が生児を得た(早産5例、満期産3例)。妊娠に至った10例中6例(60%)が体外受精・胚移植を行っていた。

記述言語：英語   出版者・発行元：(一社)日本癌治療学会  

記述言語：日本語   出版者・発行元：Turkish Journal of Obstetrics and Gynecology  

Objective: Prognostic biomarkers in patients with advanced cervical cancer treated with immune checkpoint inhibitors remain unclear. An evaluation of combined positive score (CPS) and tumor proportion score (TPS), and a comparison of their usefulness with inflammatory biomarkers in real-world data could be informative. Materials and Methods: We analyzed 28 patients who were treated with the KEYNOTE-826 regimen between November 2022 and June 2024. The complete cohort (group 1), patients with no prior chemotherapy (group 2), and treatment-naïve (group 3) were evaluated as follows: 1) CPS, TPS, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and hemoglobin, albumin, lymphocyte, and platelets (HALP score) in peripheral blood samples were obtained prior to initial treatment and KEYNOTE-826 regimen, and receiver operating curve analysis was used to compare them. The optimal cut-off values that showed the highest level of discrimination for progression-free survival were identified. Results: The areas under the curve (AUC) for progression-free survival in group 2 were measured for CPS, TPS, NLR, PLR, and HALP scores before the KEYNOTE-826 regimen. The AUC values for these scores were 0.644, 0.662, 0.852, 0.667, and 0.700, respectively. The lower NLR (≤5.52) group had a significantly longer median survival than the higher NLR (>5.52) group (p˂0.001), with median survivals of 14.0 vs. 7.6 months, respectively. In group 3, CPS and TPS were highest at 0.700 for predicting progression-free survival, compared to NLR, PLR, and HALP score. CPS and TPS appear positively correlated with progression-free survival. Conclusion: CPS and TPS showed a modest correlation with progression-free survival and NLR prior to immunotherapy demonstrated the best treatment efficacy for advanced cervical cancer.

DOI： 10.4274/tjod.galenos.2025.93607

Scopus

PubMed

記述言語：日本語   出版者・発行元：Medicina Lithuania  

Background and Objectives: The causes and clinical outcomes of renal perfusion abnormalities occurring after para-aortic lymphadenectomy (PANDx) for gynecologic malignancies are unknown. We investigated the potential involvement of accessory renal artery (ARA) obstruction in their development by reassessing perioperative contrast-enhanced computed tomography (CECT). Materials and Methods: This retrospective study investigated a clinical database to identify urinary contrast defects using CECT in all patients who had undergone PANDx between January 2020 and December 2024. The perfusion defects in the kidney detected by CECT were extracted by a gynecologic oncologist and evaluated by a radiologist and urologist for suspected obstruction of ARAs. Results: Postoperative renal contrast defects were observed in 3.8% (6/157) of patients. Renal parenchymal fibrosis, cortical atrophy, and parenchymal thinning were observed as universal findings in all patients showing renal contrast defects. In five of the six cases, ARAs supplying the infarcted renal segments were identified on preoperative CECT, and arterial obstruction was confirmed on postoperative imaging. The remaining case was considered to be latent pyelonephritis. All five patients underwent laparotomy, and preoperative CECT failed to detect ARAs. The median resected para-aortic lymph node was 23 nodes (range: 15–33) in five patients, showing no statistically significant difference compared to patients without perfusion abnormalities (p = 0.19). Postoperative serum creatinine levels remained stable. Conclusions: ARA obstruction appears to be a risk factor for segmental renal infarction after para-aortic lymphadenectomy in gynecological malignancies; however, the clinical impact on urinary function may be limited. Awareness of this potential complication is essential for gynecologic oncologists performing PANDx.

DOI： 10.3390/medicina61081395

Scopus

PubMed

記述言語：日本語   出版者・発行元：Gynecology and Minimally Invasive Therapy  

Objectives: Minimally invasive surgery (MIS) for cervical cancer is associated with poorer outcomes compared with open surgery. The Laparoscopic Approach to Cervical Cancer trial revealed an increased recurrence and mortality risk after MIS. We aimed to compare the long-term outcomes of laparoscopic radical hysterectomy (LRH) with those of sentinel node navigation surgery (SNNS) and open surgery for cervical cancer, emphasizing techniques to prevent cancer spillages. Materials and Methods: We retrospectively analyzed data from 103 patients with cervical cancer who underwent radical hysterectomy at Kagoshima University Hospital between 2007 and 2023. The patients were divided into the LRH with SNNS and open surgery groups. All LRH procedures involved closing the vagina using a vaginal cuff without a uterine manipulator. Clinicopathological factors and oncological outcomes, including 5-year recurrence-free survival (RFS) and overall survival (OS), were compared between the groups. Results: The 5-year RFS and OS rates were 92.7% and 94% and 85.5% and 88.3% for LRH and open surgery, respectively, with no significant intergroup differences. No peritoneal dissemination or recurrence was observed in the LRH group. LRH with SNNS procedure achieved 100% sentinel node identification, and lower extremity lymphedema or pelvic lymphocele did not occur. Conclusion: LRH with SNNS and open surgery for cervical cancer exhibited comparable long-term outcomes. Vaginal closure using a vaginal cuff without a uterine manipulator is crucial for preventing cancer spillage. Combining LRH with SNNS is less invasive and avoids compromising oncological outcomes. High-quality randomized controlled trials are required to validate these findings.

DOI： 10.4103/gmit.GMIT-D-24-00003

Scopus

PubMed

記述言語：英語   出版者・発行元：シュプリンガー・ジャパン(株)  

肥満(BMI 30kg/m2以上)がIA期子宮体癌患者に対するロボット支援下手術の手術成績(手術時間、周術期合併症、予後)および手術費を含む入院費用に与える影響について検討した。2018年4月から2023年9月までに当施設でda Vinciサージカルシステムによるロボット支援子宮全摘出術が施行されたIA期子宮体癌患者197例(年齢28～89歳)を、BMI<30kg/m2群117例とBMI≧30kg/m2群80例に分類した。追跡期間の中央値は34.9ヵ月(範囲6.1～84.2)であった。BMI<30kg/m2群に比べて、BMI≧30kg/m2群では、糖尿病(19.7%対51.3%)、高血圧(43.6%対58.8%)、高脂血症(29.9%対50%)の割合が有意に高かった。しかし、手術時間、出血量、周術期合併症発生率、5年癌特異的生存率(BMI≧30kg/m2群:97.6%対BMI<30kg/m2群:100%)には有意差は認めなかった。BMI≧30kg/m2群では、手術費用と入院費用が高く、患者と医療施設双方に経済的負担が生じていた。さらに、追跡調査期間中に新たに発症した生活習慣病(心血管疾患や糖尿病など)の有病率もBMI≧30kg/m2群で高かった(2.5%対10%)。以上より、肥満(BMI≧30kg/m2)は手術成績や癌予後に有意な影響を与えなかったが、治療費や生活習慣病リスクの増加をもたらした。

記述言語：英語   出版者・発行元：John Wiley & Sons Australia, Ltd  

婦人科癌に対する傍大動脈リンパ節郭清術(PANDx)の手術転帰の改善における術前三次元CT(3DCT)の有用性について検討した。2023年1月～2024年11月にPANDxを施行した婦人科癌患者72例を非3DCT群(造影CTを実施、38例)と3DCT群(34例)へ分類した。3DCT群では14例(41.2%)に腎血管バリエーション、2例(5.9%)に重複尿管を認めたのに対し、非3DCT群では解剖学的異常は認めなかった。術後合併症は非3DCT群でやや高率であり、lymphocyte infection、乳び漏、腸閉塞を認めた。術後CTにおける造影効果の均一性について検討した結果、最も複雑な尿路血管バリエーションを有する3DCT群の1例で右腎下極に造影効果の低下を認めた。また、3DCT群の8例(23.5%)では一側または両側腎動脈が腎静脈下端の尾側に位置していた。婦人科癌において、PANDx施行前の3DCTは従来の造影CTに比較して尿路血管バリエーションの同定に優れていると考えられた。

記述言語：日本語   出版者・発行元：Journal of Obstetrics and Gynaecology Research  

Background: The evaluation of anatomical abnormalities involving urinary vessel variations prior to para-aortic lymphadenectomy in gynecological malignancies is challenging. In this context, the utility of preoperative three-dimensional (3D) computed tomography (3DCT) angiography in improving surgical outcomes was examined. Methods: This retrospective study evaluated the utility of 3DCT in patients who underwent para-aortic lymphadenectomy between January 2023 and November 2024. 3D fusion images were constructed from the arterial phase, CT-venography, and CT-urography. A total of 72 patients were included and divided into two groups: non-3DCT and 3DCT. Outcomes included detection rates of arterial, venous, or urinary tract variations and surgical outcomes, including complications, in both groups. Results: The 3DCT group included 14/34 (41.2%) cases with renal vessel variations and two cases (5.9%) with double ureters; the non-3DCT group did not detect any anatomical abnormalities. In the 3DCT group, renal vessel and urinary tract variations were clearly shown. Postoperative complications tended to be slightly higher in the non-3DCT group, including lymphocyte infection, chylous leakage, and bowel obstruction. Postoperative CT revealed reduced contrast in the lower pole of the right kidney in the 3DCT case with the most complex urinary vessel variations. Furthermore, in the 3DCT group, 8/34 (23.5%) unilateral or bilateral renal arteries were located caudally to the lower edge of the renal vein. Conclusion: In gynecological malignancies, 3DCT before para-aortic lymphadenectomy seems superior in identifying urinary vessel variations over conventional contrast-enhanced CT; thus, aiding realistic preoperative simulations and potentially reducing surgeons' burden and perioperative complications.

DOI： 10.1111/jog.16367

Scopus

PubMed

記述言語：英語  

DOI： 10.7759/cureus.87200

PubMed

記述言語：日本語   出版者・発行元：Medicina Lithuania  

Background and Objectives: The aim of this prospective study was to evaluate the diagnostic accuracy of the one-step nucleic acid amplification (OSNA) assay for the intraoperative assessment of sentinel lymph node (SN) metastases, including micrometastases in patients with stage IA low-grade endometrial cancer. Materials and Methods: A prospective analysis was conducted on 204 patients with low-risk endometrial cancer who underwent hysterectomy, bilateral salpingo-oophorectomy, and sentinel node navigation surgery. SNs were analyzed intraoperatively using the OSNA assay, and positive patients underwent systematic pelvic lymphadenectomy. Results: Among the 204 patients included, SN metastases were identified in 12 patients (6%), including 10 patients with micrometastases and 2 patients with macrometastases. No metastases were detected in non-SNs in any of the 12 patients. Recurrence occurred in two patients (1%), involving the vaginal stump and pelvic cavity dissemination, but no lymph node recurrence was observed. The OSNA assay identified a proportion of micrometastases in low-risk endometrial cancer. While a direct comparison with conventional pathological ultra-staging was not performed in this study, the detection rate of micrometastases appears higher than that reported in historical controls. Conclusions: This is the first prospective study to evaluate the intraoperative use of the OSNA assay for whole SNs in endometrial cancer. The results suggest that the OSNA assay enhances the detection of micrometastases, enabling a more accurate assessment of SN metastases. In low-risk endometrial cancer, systematic pelvic lymphadenectomy may be safely omitted in patients with SN-positive micrometastases. Further prospective studies are necessary to validate these findings and support the adoption of this approach in clinical practice.

DOI： 10.3390/medicina61071221

Scopus

PubMed

記述言語：日本語   出版者・発行元：International Journal of Clinical Oncology  

Background: The incidence of endometrial cancer in Japan has more than doubled over the past 2 decades because of increasing obesity rates and the unique physiological traits of Asian populations. The aim of this retrospective study was to examine the impact of obesity on surgical outcomes, prognosis, and costs. Methods: A total of 197 patients with stage IA endometrial cancer who underwent robot-assisted hysterectomy, bilateral salpingo-oophorectomy, and lymphadenectomy/biopsy from 2018 onward were included. Patients were divided into the BMI < 30 kg/m² group (n = 117) and the BMI ≥ 30 kg/m² group (n = 80). The clinical and pathological factors, surgical outcomes, perioperative complications, and treatment costs were compared. The median follow-up period was 34.9 months (range: 6.1–84.2). Results: In the BMI ≥ 30 kg/m² group, significant differences in comorbidities, including diabetes mellitus (19.7% vs. 51.3%), hypertension (43.6% vs. 58.8%), and hyperlipidemia (29.9% vs. 50%), were detected. However, no significant differences were found in operative time, blood loss volume, perioperative complication rates, or 5-year cancer-specific survival rates (97.6% vs. 100%). Surgical and hospitalization costs were higher in the BMI ≥ 30 kg/m² group, indicating a financial burden for both patients and healthcare facilities. Additionally, a higher prevalence of newly developed lifestyle-related diseases, such as cardiovascular diseases and diabetes, was observed during the follow-up (2.5% vs. 10%). Conclusions: While obesity (BMI ≥ 30) did not significantly impact surgical outcomes or cancer prognoses, it did increase treatment costs and the risk of lifestyle-related diseases. Thus, preventive strategies, including lifestyle counseling, are needed to reduce obesity-related health burdens.

DOI： 10.1007/s10147-025-02772-8

Scopus

PubMed

記述言語：日本語   出版者・発行元：Medicina Lithuania  

Background and Objectives: To evaluate the feasibility and clinical outcomes of a novel non-mesh robot-assisted sacrocolpopexy (RSC) using autologous round ligament (ARL) grafts in patients with pelvic organ prolapse (POP). Materials and Methods: This retrospective study included 92 patients who underwent non-mesh RSC with ARL grafts at Kagoshima University Hospital between August 2020 and June 2024. All patients met the inclusion criteria for symptomatic POP-Q stage II or higher and elected to undergo non-mesh RSC. The procedures were performed using the da Vinci^® Xi or the hinotori™ Surgical Robot System. The clinical characteristics, operative data, complications, and recurrence rates were analyzed. Results: ARL harvesting was feasible in all patients, and the non-mesh RSC procedure was completed without conversion to open surgery or any intraoperative complications. The median operative time was 251 min, and the median blood loss was 30 mL. Postoperative complications of Clavien-Dindo grade ≥ 2 occurred in five patients (5%), all of whom developed pelvic infections. De novo stress urinary incontinence was observed in one patient (1%). POP recurrence occurred in seven patients (8%) during a median follow-up of 3 months (range, 3–18 months), all of whom presented with cystocele. Five patients underwent reoperation, and two were managed conservatively. All patients experienced postoperative symptomatic improvement. A higher BMI and advanced POP-Q stage were significant predictors of recurrence. Conclusions: This is the first report of non-mesh RSC using an ARL graft. The procedure is feasible and effective, avoids the use of synthetic mesh, and offers short-term outcomes comparable to those of mesh-based RSC. ARL-based RSC represents a promising alternative, especially for patients at risk of mesh-related complications. Long-term follow-up is required to confirm durability.

DOI： 10.3390/medicina61071242

Scopus

PubMed

記述言語：日本語   出版者・発行元：Japanese Journal of Clinical Oncology  

Background Automated performance metrics (APMs) are potentially useful to accurately assess and improve surgeon skills and patient outcomes, while their clinical use is currently limited. We report on the use of the Medicaroid Intelligent Network System (MINS™), a network support system platform used together with the "hinotori"surgical robot system (hinotori™) for the collection of data logs from surgeries, and discuss its potential to improve surgical outcomes. Methods This study prospectively evaluated the efficacy of MINS™ for collecting data logs in gynecologic oncologic robotic surgery between December 2022 and February 2024 in nine patients. MINS™ regularly communicated with the hinotori™ via a secure network to collect and send system logs to a cloud server, quantifying various performance data for the evaluation of surgical outcomes. Results Clinical data on hinotori™ movement were successfully extracted. The number of operation arm (OA) changes was significantly higher in Patient No. 7, who underwent pelvic lymph node dissection. OA3 monopolar was used more frequently than OA1 bipolar for coagulation (mean: 6.7% vs 2.5%, P=0.001). The error count and percentage of inactive time associated with OA collisions decreased dramatically after Patient No. 6, following the version upgrade in July 2024. Conclusion MINS™ utilizes technology to connect the hinotori™ to various systems via the Internet, allowing objective evaluations of surgical procedures from data logs. MINS™ is a clinically applicable APM system that objectively analyzes a surgeon's individuality and has the potential to improve surgical techniques and promote standardization.

DOI： 10.1093/jjco/hyaf031

Scopus

PubMed

記述言語：日本語   出版者・発行元：(株)メジカルビュー社  

記述言語：英語   出版者・発行元：Oxford University Press  

Medicaroid Intelligent Network System(MINS)はhinotoriサージカルロボットシステムをインターネット経由で様々なシステムに接続できるようにするネットワークプラットフォームであり、ロボット支援手術のデータログ記録を可能とする。本研究ではMINSを婦人科腫瘍ロボット手術で使用した経験を報告し、潜在的に手術成績を改善する能力が認められるか検討した。2022年12月～2024年2月に当院で上記の手術を行った患者9名(年齢38～71歳)を前向きに組み入れた。MINSを併用することでhinotoriロボットの動作についての臨床データを抽出することに成功した。そのデータを解析したところ、骨盤リンパ節郭清術が行われた患者1名では操作アーム(OA)の交換回数が有意に増加していた。凝固処置に用いられたOAの使用頻度は、バイポーラー式のOAよりもモノポーラー式OAの方が有意に高かった。OAの衝突に関連したエラー数および不働時間率は、2024年7月にバージョンがアップグレードされた後、6番目の患者以降で劇的に低減した。臨床適用可能なパフォーマンス自動計量システムであるMINSを用いれば執刀医の個性を客観的に分析できると考えられた。

記述言語：英語  

DOI： 10.7759/cureus.85651

PubMed

記述言語：日本語   出版者・発行元：Cancers  

Objective: This study aimed to evaluate the reliability and clinical utility of intraoperative sentinel lymph node (SN) metastasis diagnosis using the one-step nucleic acid amplification (OSNA) assay in early-stage cervical cancer by comparing its accuracy with conventional histopathological examination. Methods: A retrospective analysis was conducted on 163 patients who underwent SN biopsy at Kagoshima University Hospital between April 2014 and December 2024. This study included 50 and 113 patients in the OSNA assay and histopathological diagnosis groups, respectively. The OSNA assay quantified cytokeratin 19 (CK19) mRNA levels to determine SN metastasis. The surgical outcomes, SN metastasis detection rates, and non-SN metastasis status were compared between the two diagnostic methods. Results: The SN metastasis detection rate was significantly higher in the OSNA group (12%) than in the pathology group (3%) (p < 0.05). The OSNA assay identified only micrometastases (+) among the positive cases, whereas histopathological diagnosis detected both macrometastases and micrometastases. No non-SN metastases were observed in any of the SN-positive cases, and no significant differences were observed in the recurrence rates between the two groups. Conclusions: The OSNA assay demonstrated a higher SN metastasis detection rate than conventional pathology and demonstrated superior sensitivity in identifying micrometastases. These findings suggest that intraoperative OSNA-based SN assessment in cervical cancer could improve staging accuracy and potentially reduce the need for systematic lymphadenectomy. However, further prospective studies are warranted to confirm these findings and establish clinical guidelines.

DOI： 10.3390/cancers17111753

Scopus

PubMed

記述言語：英語  

DOI： 10.7759/cureus.84699

PubMed

記述言語：英語   出版者・発行元：シュプリンガー・ジャパン(株)  

早期子宮頸癌患者における妊孕性温存を目的としたロボット支援下子宮頸部切除術(RRT)の安全性、有効性、治療成績について検討するため、前向き単群第II相試験を実施した。2018年2月から2022年5月までに患者8例(年齢21～39歳)を登録し、BMIの中央値は21.8、腫瘍サイズの中央値は11.5mm(範囲0～30mm)であった。ハイブリッドセンチネルリンパ節ナビゲーション手術を併用したRRTは全例で成功した。新しい小型ノブ超音波プローブによる正確な子宮頸部切断線、非吸収性モノフィラメント縫合糸による適切な子宮頸管縫縮術を確認し、連続したバーブ付きU字縫合による腟-子宮吻合の緩みを回避できた。開腹手術や広汎子宮全摘術への転換例は1例もなく、重大な合併症もなかった。追跡期間の中央値は49.5ヵ月(範囲21～58ヵ月)であり、疾患の再発はなかった。以上より、RRTはradicalityを損なうことなく、新しい技術を用いても安全かつ実施可能であり、侵襲性も低かった。

記述言語：日本語   出版者・発行元：International Journal of Clinical Oncology  

Objective: The importance of minimally invasive fertility-sparing surgery for cervical cancer is gaining increasing interest, both to achieve a cure and for future fertility. Procedures for robotic radical trachelectomy involving uterine reconstruction are not fully established. Methods: This study prospectively verified the feasibility and safety of robotic radical trachelectomy between February 2018 and May 2022. The criteria were almost identical to those for our standard abdominal radical trachelectomy. Larger tumors (> 2 cm in diameter) were acceptable for surgery, provided a secure ≥ 1 cm cancer-free space was identified between the tumor and internal os. Results: Eight patients (median age, 32 y) were registered; the median body mass index was 21.8, and the median tumor size was 11.5 mm (range 0–30 mm). Robotic radical trachelectomy could be achieved in all patients with hybrid sentinel lymph node navigation surgery, confirming the precise cervical amputation line with a newer small knob ultrasonography probe, adequate cervical cerclage with non-absorbable monofilament stitches, and avoiding looseness between vaginal–uterine anastomosis with uninterrupted barbed U-shaped sutures. None of the cases were converted to laparotomy or radical hysterectomy, and there were no major complications. The median follow-up period was 49.5 mo (range 21–58 mo) and no patient had disease recurrence. Conclusion: Robotic radical trachelectomy is safe and feasible using newer technologies without reducing radicality; it is also less invasive. Procedures are consistently reproducible and have the potential to be generalized to minimally invasive approaches.

DOI： 10.1007/s10147-025-02718-0

Scopus

PubMed

記述言語：英語  

DOI： 10.7759/cureus.83750

PubMed

記述言語：日本語   出版者・発行元：Japanese Journal of Clinical Oncology  

Objectives: This study aimed to compare the surgical outcomes of simple hysterectomy with sentinel lymph node biopsy for low-risk endometrial cancer performed using the hinotori^TM Surgical Robot System and the da Vinci® Xi system. Materials and Methods: We retrospectively analyzed the data of 234 patients who underwent simple hysterectomy with sentinel lymph node biopsy at Kagoshima University Hospital between January 2017 and June 2024. Amongst them, 20 patients underwent surgery using the hinotori^TM Surgical Robot System and 214 using the da Vinci® Xi. Surgical factors, including operative time, cockpit/console time, blood loss and sentinel lymph node detection, were evaluated. Statistical analyses included chi-square and Wilcoxon tests, with significance set at P < 0.05. Results: The median operative and cockpit/console times were comparable between the two systems. However, the time from roll-in to the start of cockpit/console surgery was significantly longer for the hinotori^TM Surgical Robot System than for the da Vinci® Xi (P = 0.0039). No significant differences were observed for blood loss, length of hospital stay, or complication rates. The sentinel lymph node detection rates and number of sentinel lymph nodes resected were similar between the two systems, with metastatic sentinel lymph node rates of 6% in both groups. Conclusion: Simple hysterectomy with sentinel lymph node biopsy performed using the hinotori^TM Surgical Robot System demonstrated outcomes comparable with those using the da Vinci® Xi system, with no significant differences in key surgical factors. These results suggest that the hinotori^TM Surgical Robot System is a viable alternative for minimally invasive surgery in low-risk endometrial cancer. Further studies with larger sample sizes are required to validate these findings.

DOI： 10.1093/jjco/hyae170

Scopus

PubMed

記述言語：日本語   出版者・発行元：Gynecologic and Obstetric Investigation  

Objectives: The high incidence of invasive cervical cancer among those who have not undergone cancer screening is a serious problem. This study aimed to investigate the utility of human papillomavirus (HPV) test results from self-collected urine and vaginal samples as screening tools. Design: The study was conducted in two steps. First, the appropriate storage container, temperature, and time until urine HPV assay performance were verified. Second, the results of spot urine testing under those conditions and of gynecologist-collected cervical and self-collected vaginal samples were compared to verify the feasibility of using the BD Onclarity® HPV assay for individuals with abnormal cervical cytology. Participants/Materials, Setting, Methods: The participants were 121 women with abnormal cervical cytology. Self-collected urine and vaginal samples, along with gynecologist-collected cervical samples, were tested for HPV using the BD Onclarity® HPV assay. The optimal conditions for urine sample storage were identified by comparing the HPV detection rates under various conditions. Results: Urine stored in a BD Probe Tec™ (QxUPT) for less than 72 h at room temperature was found to have the highest HPV positivity rate. Under these conditions, the detection rates of HPV in urine, cervical, and vaginal samples were examined. HPV type 16 was detected in 41.7% of the cervical samples, type 18 in 10%, and types 31 and 52 in 12.6% each. The concordance rate for HPV testing between clinician-collected cervical and urine samples was 63.9% (kappa: 0.34; 95% CI: 0.21–0.47), and that between clinician-collected cervical and self-collected vaginal samples was 77.8% (kappa: 0.68; 95% CI: 0.53–0.83), indicating good concordance. In a population with an HPV-related lesion/ tumor prevalence of approximately 70%, the sensitivity of HPV testing was 82.7% for the cervix, 46.4% for urine, and 75.7% for vaginal samples. Limitations: The primary limitation is the lower detection rate of HPV in spot urine samples than in other sample types, indicating room for methodological improvement. The study’s findings are based on a specific population, which may limit generalizability. Conclusions: We investigated the optimal self-collected urine-to-testing time and temperature. Self-collected vaginal and urine HPV tests show moderate-high concordance with clinician-collected cervical HPV tests, suggesting their potential utility for women who do not undergo regular cancer screening. However, the sensitivity was not high in spot urine. Therefore, further large-scale studies are needed to verify these findings and optimize testing methods to encourage broader participation in cancer screening programs.

DOI： 10.1159/000541641

Scopus

PubMed

記述言語：日本語   出版者・発行元：Gynecology and Minimally Invasive Therapy  

Objectives: Laparoscopic surgery improves patient quality of life; however, its utility in stage IA1 cervical cancer remains debatable. This study aimed to compare the surgical and oncological outcomes of laparoscopic versus open surgery in patients with stage IA1 cervical cancer. Materials and Methods: Thirty-four patients, including 20 who underwent laparoscopic surgery and 14 who underwent open surgery, were enrolled in this study. The surgical and oncological outcomes were compared between the laparoscopic and open surgery groups. Results: No statistically significant differences were observed between the laparoscopic and open surgery groups in terms of median age, body mass index, final pathological type, the presence of lymphovascular space invasion, and operation time. Patients who underwent laparoscopic surgery had significantly lower blood loss (38 vs. 170 mL, P < 0.001) and shorter postoperative hospital stay (5 vs. 7.5 days, P < 0.0001) than those who underwent open surgery. Oncological recurrence was observed in only one patient in the laparoscopic group (vaginal cuff). The 3-year recurrence-free survival rate was 94.7% and 100% for the laparoscopic and open surgery groups, respectively, with no statistically significant difference. Conclusion: Laparoscopic surgery resulted in reduced blood loss and shorter hospital stay, with oncological outcomes comparable to those of open surgery in patients with stage IA1 cervical cancer. These findings highlight the potential benefits of laparoscopic surgery in improving surgical outcomes for patients with stage IA1 cervical cancer.

DOI： 10.4103/gmit.GMIT-D-24-00019

Scopus

PubMed

記述言語：日本語   出版者・発行元：Gynecology and Minimally Invasive Therapy  

Objectives: Numerous studies have compared robotic sacrocolpopexy (RSC) and laparoscopic sacrocolpopexy; however, comparisons of RSC with the hinotori™ surgical robot system (SRS) are limited. This study aimed to compare surgical factors and outcomes of RSC using the hinotori™ SRS and da Vinci® Xi for pelvic organ prolapse. Materials and Methods: A retrospective analysis was conducted on 80 patients who underwent RSC at Kagoshima University Hospital between January 2017 and June 2024. Patients were divided into two groups based on the robotic system used: hinotori™ SRS (n = 22) and da Vinci® Xi (n = 58). Surgical factors, including operative time, cockpit/console time, blood loss, length of hospital stay, and complications, were evaluated. Results: The median operative time and cockpit/console times for the hinotori™ SRS were 286 (range: 185-612) min and 250 (123-440) min, respectively, and those for the da Vinci® Xi were 221 (150-430) min and 194 (93-337) min, respectively; values for the hinotori™ SRS were significantly higher. No significant differences were found in blood loss, length of hospital stay, or complications between the two groups. The longer operative times for the hinotori™ SRS were likely due to the learning curve associated with fewer cases. Conclusion: Despite longer operative times, the hinotori™ SRS demonstrates surgical outcomes comparable to those of the da Vinci® Xi, indicating that RSC can be performed safely and effectively using the hinotori™ SRS. Future studies with larger sample sizes are needed to validate these findings.

DOI： 10.4103/gmit.GMIT-D-24-00018

Scopus

PubMed

記述言語：英語  

DOI： 10.7759/cureus.82341

PubMed

記述言語：英語   出版者・発行元：Oxford University Press  

低リスク子宮体癌に対する単純子宮全摘出術とセンチネルリンパ節(SN)生検の併用において、hinotori手術ロボットシステム(SRS)とda Vinci Xiシステムの術後成績を比較検討した。2017年1月から2024年6月までに当院でSN生検を伴う単純子宮全摘出術を施行した234例のデータを後ろ向きに解析した。そのうち、hinotori SRSを用いた手術は20例、da Vinci Xiシステムを用いた手術は214例であった。手術時間、コックピット/コンソール時間、出血量、SN検出などの手術因子を評価した。その結果、手術時間とコックピット/コンソール手術時間の中央値は両システム間で同等であった。しかし、ロールインからコックピット/コンソールでの手術開始までの時間は、da Vinci Xiよりもhinotori SRSの方が有意に長かった。出血量、入院期間、合併症発生率に有意差は認められなかった。SN検出率および切除したSN数は両システム間で同程度であり、転移性SN率は両群とも6%であった。

記述言語：英語  

DOI： 10.7759/cureus.82644

PubMed

記述言語：英語  

DOI： 10.7759/cureus.82469

PubMed

記述言語：英語  

DOI： 10.7759/cureus.81672

PubMed

記述言語：英語   出版者・発行元：John Wiley & Sons Australia, Ltd  

異型腺細胞(AGC)の臨床病理学的アウトカムと医師の認識度について検討した。頸管スミアで得られた238検体のうち子宮内膜癌などを除外した後、AGCを認める98例(中央値42歳)を対象とした。「特定不能」(NOS)や「腫瘍性を示唆」(FN)の細胞診所見のサブカテゴリー、診断検査法、治療法、アウトカムを評価し、さらに産婦人科医134名を対象にAGCに対する認識と診療に関するサーベイ調査を行った。AGC 98例のうちAGC-FNが19.8%、AGC-NOSが13.2%、非特異的が67.3%と診断され、初回検査時には44.9%が腫瘍性病変なしと判定されたが、その後の経過観察にて腫瘍性病変なしの症例の割合は38.8%に減少し、上皮内腺癌(AIS)や子宮頸部腺癌が検出された。最終的にAISが28.5%、CINが18%、その他の悪性疾患が13.3%であり、過剰診断や過小診断が生じていることが示唆された。医師を対象としたサーベイ調査の結果、AGCのサブカテゴリーを理解していたのは25%、精通していたのは11.9%にとどまっており、腫瘍性病変がみられない症例に対しても3～4ヵ月ごとに細胞診を実施していた医師は80%に達していた。AGCへの対応には課題が多いことが明らかになった。

記述言語：日本語   出版者・発行元：鹿児島産科婦人科学会  

症例は80歳、0妊0産で、かかりつけ医で膀胱腫大を指摘され、子宮悪性腫瘍疑いで紹介受診した。62歳時に胃癌I期(T1bN0M0)の手術歴があり、CTでは有意なリンパ節腫大や遠隔転移を疑う所見はなかったが、PET-CTでは子宮に子宮体癌を疑う腫瘤状の不均一な集積を認めた。子宮体癌IB期の術前診断で単純子宮全摘出術+両側付属期摘出術を行い、病理組織検査では子宮筋層を主座とする印環細胞、腫瘍細胞の全層性の筋層浸潤と漿膜浸潤を認めた。免疫染色ではCDX-2、CK7、CK20、HNF4αが陽性であり、病理学的にも胃癌組織と体癌組織が類似した印環細胞癌であったことより、胃癌の転移性子宮体癌と診断した。本症例は術前検査では胃癌の転移性子宮体癌の診断には至らなかったが、癌の既往歴がある場合には転移性子宮体癌の可能性について慎重に判断する必要があると考えられた。

記述言語：日本語   出版者・発行元：鹿児島産科婦人科学会  

症例は68歳、6妊3産で、外陰部そう痒感を主訴とした。15年前に子宮頸部扁平上皮癌(SCC)IIIB期に対する同時化学放射線療法(CCRT)の治療歴があり、前医腟鏡診で腟内に腫瘤を認め、子宮頸癌の再発疑いで紹介受診した。腫瘍マーカーではNSEの上昇を認め、MRIでは膀胱頸部～尿道の一部を全周性に占拠し、一部は腟壁へ及ぶ辺縁不整な腫瘤性病変を認めた。PET-CTでは腟部腫瘍以外に全身のリンパ節に集積を認め、子宮腟部細胞診で小型類円形の異型細胞を認めた。腟壁腫瘤生検で小細胞神経内分泌癌(SCNEC)を疑う所見を認めたことより、子宮頸部SCNEC IVB期と診断し、放射線療法後の二次性癌の可能性は低くないと考えられた。化学療法施行により原発巣、転移巣とも腫瘍は縮小している。子宮頸癌CCRT後に異なる組織型で二次性癌を発症することを念頭に置いてフォローする必要があると考えられた。

記述言語：日本語   出版者・発行元：Journal of Obstetrics and Gynaecology Research  

Objective: This study evaluates clinicopathological outcomes and clinicians' awareness regarding the management of atypical glandular cells (AGC). Methods: We analyzed 98 AGC cases, excluding known endometrial cancer, from 238 initial cases, with a median age of 42 years (range 20–82). Cytological findings, including NOS and FN subcategories, diagnostic tests, treatments, and outcomes were evaluated. A survey on AGC awareness and practices was conducted among 134 obstetrician-gynecologists. Results: Of 98 cases (AGC-FN: 19.8%, AGC-NOS: 13.2%, unspecified: 67.3%), 44.9% initially showed no neoplasia; this dropped to 38.8% following up, identifying 11 additional AIS or cervical adenocarcinomas. Overall, 28.5% had AIS or more, 18% had CIN, and 13.3% had other malignancies, indicating some over/underdiagnosis. HPV testing in 79 cases showed a 48.1% positivity rate, including 14 type-18 and 12 type-16 cases. Among clinicians surveyed, 25% were aware of AGC subcategories, and only 11.9% were well-versed. Approximately 65% associated AGC with malignancy or precancerous lesions, and 52.6% used multiple diagnostic methods simultaneously. Even in the absence of neoplasia, 80% continued cytological examinations every 3–4 months. Conclusion: This study underscores the challenges in AGC management, highlighting the importance of follow-up and collaboration between clinicians and cytopathologists to detect significant lesions. It also emphasizes the need for providing learning opportunities for clinicians to address over/undertreatment.

DOI： 10.1111/jog.16269

Scopus

PubMed

記述言語：英語  

DOI： 10.7759/cureus.78975

PubMed

記述言語：日本語   出版者・発行元：(公社)日本産科婦人科学会  

記述言語：日本語   出版者・発行元：(公社)日本産科婦人科学会  

記述言語：英語   出版者・発行元：シュプリンガー・ジャパン(株)  

日本人子宮体癌患者に対する上腹部手術と下腹部手術の両方で臍の高さに横方向に並べたポートを設置するデュアルドッキングロボット手術の実施可能性と安全性を前向きに検証するための単施設研究を実施した。2017年3月から2021年12月までに募集した患者15例(年齢28～72歳)を対象とした。主要転帰は手術完遂率で、副次的転帰は出血量、手術時間、予想外のポート留置、変更、合併症、入院期間、生存率であった。大部分の患者(14/15例、93%)はポートを追加することなくデュアルドッキングロボット手術を受け、1例は開腹手術に変更された。出血量の中央値は162mL(範囲20～685mL)であった。手術時間中央値は上腹部で183分、下腹部で206分であった。切除した傍大動脈リンパ節数の中央値は19個(範囲6～29個)、骨盤リンパ節数は28個(範囲15～42個)であった。術中の鉗子の移動に困難はなかったが、血管損傷、骨盤膿瘍などの大きな合併症が認められた。側方ポートはどのような体型の患者でも6～10cm離して設置することができた。以上より、子宮体癌に対するデュアルドッキング手術は、習熟にはより多くの症例数が必要であったが、ロボットによる子宮体癌手術の標準的な手技となる可能性があった。

記述言語：日本語   出版者・発行元：International Journal of Clinical Oncology  

Background: The standard for robotic para-aortic lymphadenectomy has not been fully established. Para-aortic lymphadenectomy performed by sharing the same ports with pelvic procedures, a procedure known as dual-docking surgery, can be performed using the latest robotic system. We prospectively examined the ability of standardized dual-docking robotic surgery in endometrial cancer patients. Methods: This study prospectively verified the feasibility and safety of dual-docking robotic surgeries performed between March 2017 and December 2021. The laterally placed ports were aligned with the umbilicus. Primary outcome was the surgical completion rate; secondary outcomes were blood loss, operative time, unexpected port placement, conversion, complications, length of hospital stay, and survival. Results: Most patients (14/15, 93%) underwent surgery using our methods without additional port placements, and one patient was converted to laparotomy. Median blood loss was 162 mL (range: 20–685 mL). Median operative time was 183 and 206 min in the upper and lower abdomen. Median number of resected para-aortic lymph nodes was 19 (range: 6–29), and pelvic lymph nodes was 28 (range: 15–42). Although there was no difficulty in moving the forceps intraoperatively, major complications including vessel injury, and pelvic abscesses were observed. The lateral ports could be placed 6–10 cm apart in patients with any range of body type. Conclusion: Dual-docking surgery for endometrial cancer has the potential to be a standard procedure for robotic endometrial cancer surgery, although a greater number of cases are needed to acquire proficiency.

DOI： 10.1007/s10147-024-02635-8

Scopus

PubMed

記述言語：日本語   出版者・発行元：Japanese Journal of Clinical Oncology  

Background: Prognostic predictors of immunotherapy in patients with advanced endometrial cancer remain unclear. The potential role of inflammatory predictors, including pretreatment neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio and hemoglobin, albumin, lymphocyte and platelet scores, was investigated. Methods: Between August 2018 and December 2023, 35 patients were retrospectively analyzed. Prognostic predictors were compared, and optimal cut-off values that exhibited the greatest discrimination for overall response, disease control, progression-free survival and overall survival were determined. Multivariate analysis was used to assess the prognostic significance of the predictors. Results: The greatest discrimination for overall response, progression-free survival and overall survival included platelet-to-lymphocyte ratio, neutrophil-to-lymphocyte ratio and hemoglobin, albumin, lymphocyte and platelet; the areas under the curve were 0.638, 0.649 and 0.641, respectively. The precise cut-off values of neutrophil-to-lymphocyte ratio for progression-free survival and overall survival were 4.92 and 5.40, respectively. The lower neutrophil-to-lymphocyte ratio group had a significantly longer progression-free survival (P = 0.001, median survival; 4.0 months vs. 19 months) and longer overall survival (P = 0.002, median survival; 5.0 months vs. 21 months). Of the risk factors assessed, neutrophil-to-lymphocyte ratio (hazard ratio = 4.409; 95% CI = 1.10-17.64; P = 0.036) and regimen (hazard ratio = 5.559; 95% CI = 1.26-24.49; P = 0.023) were independently correlated with overall survival. Conclusion: In patients with advanced endometrial cancer, pretreatment neutrophil-to-lymphocyte ratio may be a prognostic predictor of those who would benefit from immunotherapy.

DOI： 10.1093/jjco/hyae123

Scopus

PubMed

記述言語：英語   出版者・発行元：Oxford University Press  

免疫チェックポイント阻害薬治療(ICI)を受けた婦人科悪性腫瘍患者において、治療効果、無増悪生存期間(PFS)、全生存期間(OS)の予測因子となりうる臨床因子を後ろ向きに検討した。2018年8月から2023年12月までに当院でICIを受けた進行・再発子宮体癌患者35例(年齢35～75歳)を対象にした。その結果、奏効率、PFS、OSに対する最大の差別化要因は、血小板対リンパ球比、好中球対リンパ球比、ヘモグロビン、アルブミン、リンパ球、血小板であり、曲線下面積はそれぞれ0.638、0.649、0.641であった。PFSおよびOSにおける好中球/リンパ球比の正確なカットオフ値は、それぞれ4.92および5.40であった。好中球/リンパ球比が低い群では、PFSが有意に長く(P=0.001、生存期間中央値;4.0ヵ月対19ヵ月)、OSも長かった(P=0.002、生存期間中央値;5.0ヵ月対21ヵ月)。評価されたリスク因子のうち、好中球対リンパ球比(ハザード比4.409;95%CI 1.10～17.64;P=0.036)およびレジメン(ハザード比5.559;95%CI 1.26～24.49;P=0.023)は、独立して全生存期間と相関していた。以上より、進行子宮体癌患者において、治療前の好中球対リンパ球比はICI療法が有効な患者の予後予測因子である可能性があった。

記述言語：日本語   出版者・発行元：Medicina Lithuania  

Background and Objectives: This study aims to evaluate and compare the safety and efficacy of the da Vinci^® Xi and hinotori™ SRS robot-assisted surgical systems for gynecologic disorders. Materials and Methods: We conducted a retrospective study of 401 cases (43 benign uterine tumors; 88 pelvic organ prolapses; 270 low-risk endometrial cancers) of robot-assisted surgery performed at Kagoshima University Hospital between January 2017 and October 2024. Surgical factors such as the operative time, blood loss, and complication rates were analyzed and compared between the da Vinci^® Xi (332 cases) and hinotori™ SRS (69 cases) systems. Complications were classified according to the Clavien–Dindo classification, with Grade 2 or higher considered significant. Results: Significant differences were observed between the two groups in terms of age, body mass index, cockpit/console time, and median time from roll-in to cockpit/console start. The cockpit/console time was significantly longer for the hinotori™ SRS system (173 min) compared to the da Vinci^® Xi (156 min; p = 0.047). No significant differences were observed in the total operative time, blood loss, or length of hospital stay. Intraoperative complications were minimal, with one case of bladder injury and one case of vascular injury recorded for the da Vinci^® Xi. The overall postoperative complication rate was approximately 4%. Conclusions: Robot-assisted surgery using both the da Vinci^® Xi and hinotori™ SRS systems was found to be safe, with minimal blood loss and a low complication rate. The hinotori™ SRS system demonstrated operative outcomes comparable to those of the da Vinci Xi^® system, suggesting that it may serve as a viable alternative. Further prospective studies are warranted to evaluate the efficacy and safety of these systems.

DOI： 10.3390/medicina60122014

Scopus

PubMed

記述言語：英語   出版者・発行元：John Wiley & Sons Australia, Ltd  

18歳女性。未妊、性交渉歴はなかった。出生時より多数のカフェオレ斑を認め、2歳時に神経線維腫症1型(NF1)と診断されていた。患者の母および母方の祖母がNF1であった。帯下異常および過長月経で近医を受診し、経直腸超音波断層法で骨盤内に手拳大の充実腫瘍を認め当院紹介となった。体幹・四肢に多発するカフェオレ斑、神経線維腫を認めた。腟鏡診では腟入口部より2cmまで白色調で壊死を伴う腫瘍が充満し、経腟超音波断層法では骨盤内に液状変性を伴う長径13cm、高輝度エコーの充実性腫瘍を認めた。PET-CTにて子宮頸部より発生した腫瘍および多発肺転移および右肩甲骨転移を認めた。全身化学療法を施行したが、腫瘍は急速に増大し、入院後8週目で敗血症性ショックにより死亡した。中央病理診断にて、ヒストンH3リジン27のトリメチル化(H3K27me3)の完全欠損を認め、NF1の病歴と併せて子宮頸部に発生した悪性末梢神経鞘腫瘍(MPNST)と診断した。

記述言語：日本語   出版者・発行元：Journal of Obstetrics and Gynaecology Research  

Malignant peripheral nerve sheath tumors (MPNSTs) of the cervix are rare, particularly in patients with neurofibromatosis type 1 (NF1). This report describes a cervical MPNST in an 18-year-old patient with no history of sexual activity, abnormal vaginal discharge, and prolonged menstruation. She had more than six café-au-lait spots on her body since birth and was diagnosed with NF1 at 2 years of age. Positron emission tomography-computed tomography revealed a large pelvic mass and lung and bone metastases. Biopsy confirmed MPNST. Immunohistochemical staining showed diffuse positivity for CD10, approximately 30% positivity for cyclin D1, partial positivity for α-SMA, desmin, and MyoD1, and negativity for myogenin, S-100, and SOX-10. A cancer gene panel identified several genetic abnormalities, but none were actionable mutations. Despite systemic chemotherapy, the tumor progressed rapidly, and the patient died 8 weeks post-admission. Early diagnosis of MPNST is crucial. In patients with NF1, even mild symptoms can indicate MPNST.

DOI： 10.1111/jog.16139

Scopus

PubMed

記述言語：日本語   出版者・発行元：International Journal of Clinical Oncology  

Background: Sentinel lymph node navigation surgery, which identifies the sentinel lymph node in early cervical cancers and omits systemic pelvic lymphadenectomy in cases where no lymph node metastasis is present, has recently gained attention. However, there are few reports on lymph node recurrence and the long-term outcomes of cervical cancer surgery performed using sentinel lymph node navigation surgery. In this study, we aimed to evaluate the long-term outcomes of sentinel node navigation surgery for early-stage cervical cancer. Methods: One hundred thirty-eight patients with cervical cancer were enrolled. Sentinel lymph nodes were identified by injecting 99 m Technetium-labeled phytate and indocyanine green into the uterine cervix. Surgery and survival outcomes were also analyzed. Results: The median age and body mass index of the patients were 40 years (20–78) and 21.7 kg/m² (16.5–50.4), respectively. Open surgery, laparoscopic surgery, and robotic surgery were performed in 77 (56%), 53 (38%), and 8 (6%) patients, respectively. The overall and bilateral detection rates of the sentinel lymph node were 100% and 94%, respectively. Only one case (0.7%) exhibited lower extremity lymphedema, and pelvic lymphocele was observed in three cases (2.2%). Four cases (3%) experienced recurrence over a median follow-up of 57.5 months (range, 2–115 months), with five-year recurrence-free and overall survival rates of 97% and 97.3%, respectively. Conclusions: Our results demonstrate that sentinel node navigation surgery may be safe and effective for early-stage cervical cancer.

DOI： 10.1007/s10147-024-02605-0

Scopus

PubMed

記述言語：英語   出版者・発行元：シュプリンガー・ジャパン(株)  

センチネルリンパ節(SN)ナビゲーション手術を施行された早期子宮頸癌患者の長期アウトカムについて検討した。子宮頸癌患者138例(中央値40歳)を対象に、99mテクネチウム標識フィチン酸とインドシアニングリーンを子宮頸部に注入してSNを同定した。組織診断にもとづく腫瘍タイプは扁平上皮癌が99例(72%)、腺癌が31例(22%)、腺扁平上皮癌が3例(2%)、その他が5例(4%)であり、FIGOステージ別にみるとIA2が23例(17%)、IB1が111例(80%)、IB2が1例(1%)、IIBが3例(2%)、術式は開腹術が77例(56%)、腹腔鏡下手術が53例(38%)、ロボット手術が8例(6%)、手術時間中央値は276分、出血量中央値は240g、在院期間中央値は6日であった。全例で計288個のSNの同定が可能であり、局在は閉鎖筋が141個(49%)、外腸骨が123個(42%)、内腸骨が17個(6%)、総腸骨が6個(2%)、傍子宮が1個(1%)で、1例あたりのSN摘出数は中央値2個、SN転移を4例(2.9%)に認め、macrometastasisが2例、micrometastasisが2例であった。骨盤内リンパ節郭清(PLA)を省略した134例のうち、1例(0.7%)に下肢リンパ浮腫(LEL)、3例(2.2%)にリンパ節嚢腫、4例(3%)に再発がみられ、再発部位は腟断端が2例、骨盤が1例、肺転移が1例で3例が死亡の転帰に至った。全138例のKaplan-Meier解析では推定5年無再発生存率(RFS)は97%、5年全生存率(OS)は97.3%であった。早期子宮頸癌に対するセンチネルリンパ節ナビゲーション手術は安全かつ有効な術式であると考えられた。

記述言語：英語  

DOI： 10.1007/s13691-024-00706-1

PubMed

記述言語：英語   出版者・発行元：シュプリンガー・ジャパン(株)  

症例は50歳女性で、妊娠歴4回、出産歴3回、子宮外妊娠歴1回で、3回の帝王切開歴があり、20歳代に背中にタトゥーを入れていた。下腹部痛のため来院し、骨盤経腹超音波検査で右骨盤腔に嚢胞性病変と壁肥厚が認められ、卵巣腫瘍が疑われて当科に紹介された。身体診察で右下腹部に鶏卵大の触知可能な弾力性のある硬性腫瘤が見られ、経腟超音波検査では右下腹部に54×58mmの腫瘍、骨盤造影磁気共鳴画像では拡散制限を伴う肥厚嚢胞壁、T1強調画像での低信号強度領域、T2強調画像でやや高信号強度領域が認められた。FDG-PET/CTで腫瘍壁にFDG蓄積が明らかになり、腹腔鏡検査で下腹壁正中線上に10cm大の白色固形腫瘍が確認され、これらの所見から悪性卵巣腫瘍が疑われた。開腹手術を行い、恥骨に付着していた腫瘍を切除した。組織学的には、放射状好塩基性沈着物、マクロファージの密な浸潤、多核巨細胞、泡状組織球が観察され、中心部にはコレステロール裂隙、フィブリン滲出、壊死が見られ、ホスホグリセリド結晶沈着症と診断した。現在外来で経過観察中であり、再発の徴候は見られず、術後転帰は良好である。

出版者・発行元：金原出版  

DOI： 10.18888/sp.0000003073

CiNii Research

記述言語：日本語   出版者・発行元：金原出版(株)  

＜文献概要＞子宮がんに対するセンチネルリンパ節(SN)生検は,術後のリンパ浮腫やリンパ嚢胞の軽減だけでなく正確な転移診断が可能であり,近年欧米では標準治療の1つとして位置づけられているが,残念ながらわが国ではまだ保険未収載である。SN生検を行ううえで最も重要なことは,真のSNを正確に同定・摘出することである。代表的な子宮がんSN同定法としては,ラジオアイソトープをトレーサーとするRI法と,インドシアニングリーンをトレーサーとする蛍光法がある。本稿では子宮がんにおけるSNの概念と,SN同定法に関して概説する。

記述言語：英語  

DOI： 10.7759/cureus.65415

PubMed

記述言語：英語  

DOI： 10.7759/cureus.62895

PubMed

記述言語：日本語   出版者・発行元：Acta Cytologica  

mutation (POLEmut) subtype, MMR-deficient (MMR-d) subtype as classified by The Cancer Genome Atlas (TCGA), and a high tumor mutation burden (TMB-high) potentially benefit from immunotherapy. However, characteristics of the cytological morphology within these populations remain unknown. Methods: DNA extracted from formalin-fixed paraffinembedded tissues was subjected to next-generation sequencing analysis. Genomic mutations related to gynecological cancers, TMB, and microsatellite instability were analyzed and were placed in four TCGA classification types. The following morphological cytological investigations were conducted on endometrial cancer using a liquid-based preparation method, prior to the commencement of initial treatment: (i) cytological backgrounds; (ii) differences between each count of neutrophils and lymphocytes as described below. Results: Insignificant differences in the cytological background patterns of TCGA groups and TMB status were found. Although there was no significant difference in neutrophil count (p = 0.955) in the TCGA groups, POLEmut and MMR-d had significantly higher lymphocyte counts than no specific molecular profile (NSMP) (p = 0.019 and 0.037, respectively); furthermore, p53mut also tended to be significant (p = 0.064). Lymphocyte counts in TMB-high were also significantly greater than TMB-low (p = 0.002). POLEmut showed a positive correlation between TMB levels and lymphocyte counts. For predicting patients with POLEmut plus MMRd, lymphocyte counts demonstrated a superior diagnostic accuracy of area under the curve (AUC) (0.70, 95% CI: 0.57-0.84), with a cutoff value of 26 high-power field. Conclusion: Lymphocyte count using liquid-based cytology for patients with endometrial cancer may predict POLEmut plus MMR-d of TCGA groups and TMB-high in those who can benefit from immunotherapy. 2024 S. Karger AG, Basel.

DOI： 10.1159/000538288

Scopus

PubMed

記述言語：日本語   出版者・発行元：鹿児島産科婦人科学会  

当院でロボット手術を行った30例を対象に、これらを70～74歳の准高齢者群(A群)17例と、75歳以上の高齢者群(B群)13例に分け、治療成績や周術期合併症を比較検討した。その結果、両群間で治療成績、周術期合併症に有意差はみられなかった。周術期リスク評価システムを用いた算定結果を含めると、年齢にかかわらずロボット手術は比較的安全に行えることが示唆された。

記述言語：日本語   出版者・発行元：Cancer Medicine  

Introduction: Hypersensitivity reactions (HSRs) to chemotherapy are serious adverse events associated with cancer drug therapy and can occur with any antitumor drug. This study investigated the safety and efficacy of carboplatin desensitization therapy in Japan and established a method for treating carboplatin HSRs. Methods: Patients diagnosed with gynecological (ovarian, endometrial, or cervical) cancers who underwent carboplatin desensitization therapy between 2016 and 2020 at the Gynecologic Cancer Study Group of Japan Clinical Oncology Group were included. The carboplatin desensitization therapy at each institution and the implementation cases were registered in an online case report form. Results: This retrospective study enrolled 136 patients (ovarian, 108; endometrial, 17; and cervical cancer, 11). Pre-existing allergies were present in 37 (27.2%) patients, and 32 (23.5%) patients exhibited prodromal symptoms during treatment before HSR onset. Erythema was the most common symptom at HSR onset, affecting 93 (68.4%) patients, followed by itching in 72 (52.9%) patients and decreased oxygen saturation in 43 (31.6%) patients. Loss of consciousness occurred in three (2.2%) patients. The most common timing of HSR onset was during the first recurrence treatment (47%). The mean total carboplatin dose until HSR onset was 7331 (2620–18,282) mg, and the mean number of doses was 14 (4–63). Desensitization treatment was completed in 75% of cases, and breakthrough HSRs occurred in 25% (34/136). No deaths occurred in the study cohort. The risk factors for HSRs were not identified. Conclusion: Although carboplatin desensitization therapy has high success rates in Japan, erythema and pruritus are important HSRs to consider.

DOI： 10.1002/cam4.6968

Scopus

PubMed

記述言語：日本語   出版者・発行元：(公社)日本産科婦人科学会  

記述言語：日本語   出版者・発行元：Taiwanese Journal of Obstetrics and Gynecology  

Objective: The incidence of left-sided inferior vena cava (IVC) is extremely low. However, without a preoperative diagnosis of left-sided IVC, the risk of intraoperative vascular injury during para-aortic lymph node (PAN) lymphadenectomy is high. Case report: Herein, we present two cases in which left-sided IVCs were diagnosed using preoperative imaging. PAN lymphadenectomies were safely performed in these patients with endometrial cancer. In the first case, the left-sided IVC crossed the abdominal aorta after the left renal and gonadal veins had drained into it and joined the right renal vein. In the second case, the left-sided IVC crossed the abdominal aorta after the left renal and gonadal veins flowed into it and the ascending lumbar vein flowed into the right side. Conclusion: These cases demonstrate that even in the presence of vascular malformations, PAN lymphadenectomy can be performed safely by employing preoperative anatomical imaging analysis and judicious intraoperative surgical maneuvers to avoid vascular injury.

DOI： 10.1016/j.tjog.2023.07.037

Scopus

PubMed

記述言語：英語   出版者・発行元：John Wiley & Sons Australia, Ltd  

ロボット支援骨盤リンパ節郭清の標準化を目的として、大腸外科、泌尿器科、婦人科による学際的議論をもとに骨盤解剖の共通理解と手術手技の策定を試みた。2020年5月～2021年11月に、大腸外科専門医5名、泌尿器科医4名、婦人科医4名が計11回に及ぶオンラインでの議論を重ねた。大腸外科、泌尿器科、婦人科ともに郭清領域として閉鎖リンパ節を挙げており、その領域の解剖学的構造に関するそれぞれの理解度を相互チェックし、膜、血管、神経などをベースとして解剖学的ランドマークの設定を図った。議論を重ねることにより、骨盤俯瞰図、中位骨盤斜位像、左側骨盤斜位像および頭側から尾側にかけての横断像に関する動的イラストレーションを得ることができた。さらに、以下の知見をイラストに落とし込んだ。基靱帯が膀胱下腹筋膜と一部重複すること、閉鎖リンパ節がMarcille窩の頭側に連続して位置していること、深部子宮静脈は下膀胱静脈に相当するものであること。

記述言語：日本語   出版者・発行元：Asian Journal of Endoscopic Surgery  

Background: Pelvic lymph node dissection is a procedure performed in gastroenterological surgery, urology, and gynecology. However, due to discrepancies in the understanding of pelvic anatomy among these departments, cross-disciplinary discussions have not been easy. Recently, with the rapid spread of robotic surgery, the importance of visual information in understanding pelvic anatomy has become even more significant. In this project, we attempted to clarify a shared understanding of pelvic anatomy through cross-disciplinary discussions. Method: From May 2020 to November 2021, a total of 11 discussions were held entirely online with 5 colorectal surgery specialists, 4 urologists, and 4 gynecologists. The discussions focused on evidence from each specialty and surgical videos, aiming to create a universally understandable pelvic anatomical illustration. Results: The common area of dissection recognized across the three departments was identified as the obturator lymph nodes. A dynamic illustration of pelvic anatomy was created. In addition to a bird's-eye view of the pelvis, a pelvic half view was developed to enhance understanding of the deeper pelvic anatomy. The following insights were incorporated into the illustration: (1) the cardinal ligament in gynecology partly overlaps with the vesicohypogastric fascia in colorectal surgery; (2) the obturator lymph nodes continue cephalad into the fossa of Marcille in urology; and (3) the deep uterine vein in gynecology corresponds to the inferior vesical vein in colorectal surgery. Conclusion: Based on the dynamic illustration of pelvic anatomy from cross-disciplinary discussions, we anticipate advancements in pelvic lymph node dissection aiming for curative and safe outcomes.

DOI： 10.1111/ases.13274

Scopus

PubMed

記述言語：日本語   出版者・発行元：International Journal of Gynecology and Obstetrics  

Objective: To compare single-photon emission computed tomography with computed tomography (SPECT/CT) and lymphoscintigraphy (LSG) for the detection of sentinel lymph nodes (SLNs) in patients with early-stage cervical cancer. Methods: This hospital-based, single-center, retrospective study included 128 patients with cervical cancer (aged >18 years) treated between 2014 and 2022. Injection of 99 m Technetium-labeled phytate into the uterine cervix was used to detect pelvic SLNs. SNL identification rates and locations were analyzed for preoperative LSG and SPECT/CT. Results: Median age and body mass index of patients were 40 years (range, 20–78 years) and 21.7 kg/m² (range, 16–40 kg/m²), respectively. There was no significant difference in overall identification rates (identification of at least one SLN) of SLNs between SPECT/CT (91%) and LSG (88%). There was no significant difference in bilateral SLN identification rates between SPECT/CT (66%) and LSG (65%). A total of 219 pelvic SLNs (110 right and 109 left hemipelvis) were identified by SPECT/CT; the most frequent locations were the obturator (122 SLNs, 56%) and external iliac (67 SLNs, 30%). Conclusion: SPECT/CT and LSG showed high SLN identification rates in patients with cervical cancer, and there was no significant difference in overall or bilateral SLN identification rates between the two techniques.

DOI： 10.1002/ijgo.14917

Scopus

PubMed

記述言語：日本語   出版者・発行元：Japanese Journal of Clinical Oncology  

Objective: This study aimed to report the first surgery for gynecological diseases using a new robotic platform, the hinotori™, and validate its feasibility in clinical settings. Methods: The world’s first robot-assisted total hysterectomy for a gynecological ailment was carried out at Kagoshima University Hospital in December 2022 utilizing the hinotori™ surgical robot system. Eleven other patients then underwent comparable procedures. The surgical team was certified to execute the procedure and had undergone official hinotori™ training. Results: Preoperative diagnoses indicated five cases of endometrial cancer, four cases of uterine myoma and one case each of atypical endometrial hyperplasia, uterine adenosarcoma and high-grade cervical intraepithelial neoplasia. Median age and body mass index were 51 (range: 38–70) years and 26.9 (range: 17.3–33.3) kg/m², respectively. Median roll-in, cockpit and operation times were 15 (range: 10–18), 161 (range: 110–225) and 214 (range: 154–287) min, respectively. The median blood loss was 22 (range: 7–83) mL and conversion to laparotomy was not allowed. Only one patient had postoperative pelvic region infection. The median length of hospital stay was 6 (range: 4–10) days. Conclusion: Based on our experience with presented 12 cases, robotic surgery with the hinotori™ is a feasible technique of minimally invasive surgery for gynecological diseases.

DOI： 10.1093/jjco/hyad105

Scopus

PubMed

記述言語：日本語   出版者・発行元：Journal of Gynecologic Oncology  

Objective: This study aimed to validate the surgical and oncologic outcomes of robotic surgery with sentinel node navigation surgery (SNNS) in endometrial cancer. Methods: This study included 130 patients with endometrial cancer, who underwent robotic surgery, including hysterectomy, bilateral salpingo-oophorectomy, and pelvic SNNS at the Department of Obstetrics and Gynecology of Kagoshima University Hospital. Pelvic sentinel lymph nodes (SLNs) were identified using the uterine cervix 99m Technetium-labeled phytate and indocyanine green injections. Surgery-related and survival outcomes were also evaluated. Results: The median operative and console times and volume of blood loss were 204 (range: 101–555) minutes, 152 (range: 70–453) minutes, and 20 (range: 2–620) mL, respectively. The bilateral and unilateral pelvic SLN detection rates were 90.0% (117/130) and 5.4% (7/130), respectively, and the identification rate (the rate at which at least one SLN could be identified on either side) was 95% (124/130). Lower extremity lymphedema occurred in only 1 patient (0.8%), and no pelvic lymphocele occurred. Recurrence occurred in 3 patients (2.3%), and the recurrence site was the abdominal cavity, with dissemination in 2 patients and vaginal stump in one. The 3-year recurrence-free survival and 3-year overall survival rates were 97.1% and 98.9%, respectively. Conclusion: Robotic surgery with SNNS for endometrial cancer showed a high SLN identification rate, low occurrence rates of lower extremity lymphedema and pelvic lymphocele, and excellent oncologic outcomes.

DOI： 10.3802/jgo.2023.34.e68

Scopus

PubMed

記述言語：英語   出版者・発行元：Oxford University Press  

婦人科疾患に対する手術用ロボットシステム「ひのとり」を用いた手術の可能性を検証した。「ひのとり」を用いたロボット支援子宮全摘術を施行した婦人科疾患患者12例(中央値51歳、BMI中央値26.9kg/m2)を対象とした。患者の術前診断では、子宮内膜癌5例、子宮筋腫4例、非定型子宮内膜増殖症、子宮腺肉腫、高悪性度子宮頸部上皮内腫瘍が各1例であった。ロールイン時間、コックピット時間、手術時間の中央値はそれぞれ15分、161分、214分であった。出血量の中央値は22mLで、開腹手術への変更はみられなかった。術後骨盤領域感染症は1例にのみ認められた。入院期間中央値は6日であった。以上のように、手術用ロボットシステム「ひのとり」を用いたロボット手術は婦人科疾患に対する低侵襲手術の実現可能な手技であることが示された。

記述言語：英語   出版者・発行元：John Wiley & Sons Australia, Ltd  

症例は38歳の女性で、下腹部痛により来院した。超音波とMRIにて右卵巣と付属器に腫瘍を認め、腹腔鏡下にて切除した。子宮内膜及び卵巣において病理学的にグレード3の類内膜癌が認められた。進行度の検査にて子宮内膜と播種結節に腫瘍を認め、直腸への浸潤も含め切除し、卵管卵巣摘除術を行った。子宮内膜癌はグレード1、子宮漿膜内の播種結節はグレード3の類内膜腺癌と診断された。synchronous endometrial and ovarian cancer(SEOC)を疑い、DNA解析を行った。その結果、SEOCではなく子宮内膜癌の卵巣転移と診断された。パクリタキセルとカルボプラチンによるアジュバント化学療法を受け、再発は認められていない。

記述言語：日本語   出版者・発行元：Journal of Obstetrics and Gynaecology Research  

The diagnosis of synchronous endometrial and ovarian cancer or metastatic cancer of the same histological type is difficult. In this study, molecular biology analysis was performed to determine ovarian metastasis from endometrial cancer. A 38-year-old woman had pathological evidence of endometrial cancer (endometrioid carcinoma, grade 1) and ovarian cancer (endometrioid carcinoma, grade 3); a disseminated nodule in the serosa uteri was also diagnosed as endometrioid carcinoma (grade 3). Customized panel sequencing revealed a common mutation pattern in ovarian cancer and disseminated nodules. Furthermore, endometrial cancer showed the same mutation patterns for FGFR3 and PTEN as ovarian cancer and disseminated nodules. All tumors were microsatellite instability high. Clinicopathological and molecular biology analyses suggested that the patient had ovarian metastasis from endometrial cancer. The patient underwent adjuvant chemotherapy with paclitaxel and carboplatin, with no recurrence. Molecular biology techniques may enable appropriate treatment based on clinically accurate diagnosis.

DOI： 10.1111/jog.15773

Scopus

PubMed

記述言語：日本語   出版者・発行元：Asian Journal of Endoscopic Surgery  

After salpingectomy, recurrent ectopic pregnancies occur in the contralateral fallopian tube. Here, we present a case of ipsilateral remnant fallopian tube pregnancy in a 30-year-old woman with a history of incomplete prior operation to remove the middle region of the left fallopian tube following fallopian tube isthmus pregnancy 6 years earlier. During the previous salpingectomy, the left fallopian tube was not completely observed because of adhesions to the pelvic peritoneum and sigmoid colon; a partial remnant may have been present. The patient presented with lower abdominal pain 6 weeks after the most recent menstrual cycle, and transvaginal ultrasonography revealed a remnant left fallopian tube ectopic pregnancy. A 4 cm-sized mass identified at the distal end of the remnant left fallopian tube and the proximal remnant tube were laparoscopically removed. The possibility of an ipsilateral remnant tubal pregnancy should be carefully considered in spontaneous pregnancy after partial fallopian tube resection.

DOI： 10.1111/ases.13226

Scopus

PubMed

記述言語：英語   出版者・発行元：John Wiley & Sons Australia, Ltd  

症例は30歳妊婦。経妊3、経産0で、妊娠7週に左下腹部痛を主訴に来院した。卵管峡部妊娠の既往があり、6年前に左卵管切除術を受けた。前回の卵管切除時に左卵管が骨盤腹膜およびS状結腸と激しく癒着していたため、完全切除できず遺残卵管の可能性があった。受診時は意識清明で、腹部に圧痛はなく、バイタルサインに異常はなかった。血液検査でヒト絨毛性ゴナドトロピンは17372mIU/mL、ヘモグロビン濃度は11.9g/dLであった。経腟超音波検査で子宮内に胎嚢は見られず、左付属器領域に胎嚢と思われる径12mmの病変を認めた。左卵巣に排卵後の黄体を認めた。右卵巣および右卵管に異常所見はなかった。造影CTで前回切除した左卵管付近に胎嚢を認め、腹膜妊娠は除外された。左卵管切除後の同側遺残卵管妊娠を疑い、緊急腹腔鏡手術を施行した。腹腔内に中等度の出血を認めた。遺残卵管の遠位部に径4cmの異所性妊娠腫瘤を認めた。左側残存卵管切除術を施行した。病理組織学的検査で摘出した左卵管に絨毛成分が検出され、遺残卵管妊娠と確定診断した。手術時間は83分、術中出血量は20mLであった。術後経過は良好で、無事退院に至った。

記述言語：日本語   出版者・発行元：Pathology Research and Practice  

Endometrial cancers are classified into mismatch repair (MMR) deficient- (MMRd), p53 mutation- (p53mut), DNA polymerase epsilon (POLE) mutation (POLEmut), and no specific molecular profile (NSMP) subtypes according to The Cancer Genome Atlas (TCGA). The distinction between POLEmut and NSMP subtypes is made on the basis of molecular analysis because the specific histological and immunohistochemical features of these two subtypes are still unknown. In this study, we analyzed histological features by scoring the presence of a mucinous pool, giant cells, clear cells, keratinization, neutrophilic abscess, and surface proliferating pattern in 82 cases of endometrial cancers in which an integrative diagnosis was confirmed by immunohistochemistry and genomic profiles showing POLE mutations, tumor mutation burden, and microsatellite instability. In contrast to the hierarchical branching of micropapillary proliferation observed in serous carcinoma, POLEmut-subtype endometrioid carcinomas often showed a surface epithelial slackening (SES) pattern in the tumor cells facing the uterine surface. The POLEmut subtype exhibited higher scores for clear cells and SES patterns than the other three subtypes. The scores for giant cells, clear cells, and the SES pattern were significantly higher in the POLEmut subtype than in the NSMP subtype, suggesting that these morphometric parameters are useful for differentiating POLEmut- and NSMP-subtype endometrioid carcinomas, although genomic profiling is still necessary for a definite molecular diagnosis.

DOI： 10.1016/j.prp.2023.154563

Scopus

PubMed

記述言語：日本語   出版者・発行元：Cytopathology  

Objective: For patients with endometrial cancer, the POLE (polymerase epsilon) mutation (POLEmut)-subtype, one of four molecular-analysis-based categories in the Cancer Genome Atlas (TCGA), has the best prognosis. The following histological characteristics are typically observed in endometroid carcinoma cases with the POLEmut-subtype: (1) the presence of tumour giant cells, (2) numerous tumour-infiltrating lymphocytes (TILs) and/or peri-tumoral lymphocytes, and (3) a high grade. However, in the context of cytology, the morphological characteristics of this subtype remain unknown. Methods: DNA extracted from formalin-fixed paraffin-embedded (FFPE) tissues was subjected to next-generation sequencing analysis and categorised according to the TCGA classifications. Genomic mutation, tumour mutation burden (TMB), and microsatellite instability were also assessed. Cytological specimens of resected uteri obtained using the Papanicolaou method were histologically separated into three types. Results: Seven out of 112 patients (6%) with endometrial cancer were diagnosed with the POLEmut-subtype between January 2019 and August 2021. Tumour giant cells were observed in three cases (43%) on histology and cytology. TIL and/or peritumoral lymphocytes with inflammatory cells were detected in five cases (71%) on histology and three cases (43%) on cytology. Cases in which these three characteristics were observed on both cytology and histology may have belonged to the POLEmut-subtype. There were no cases in which these characteristics were absent on histology but present on cytology. TMB tended to be higher in cases when the three characteristics were observed in both cytological and histological findings. Conclusions: Preoperative endometrial cytology highlighted the characteristics of the POLEmut-subtype in the histological analysis of resected uterine specimens and has the potential to play an important role in treatment decisions.

DOI： 10.1111/cyt.13215

Scopus

PubMed

記述言語：英語  

DOI： 10.7759/cureus.39410

PubMed

出版者・発行元：株式会社医学書院  

DOI： 10.11477/mf.1409210892

CiNii Research

記述言語：日本語   出版者・発行元：(株)医学書院  

＜文献概要＞●子宮体がんに対するセンチネルリンパ節生検は,術後の下肢リンパ浮腫,骨盤リンパ嚢胞の軽減だけでなく,リンパ節転移の診断率向上ももたらし,欧米ではリンパ郭清に代わるステージング法として位置づけられている.●国内でも多くの施設で子宮体がんセンチネルリンパ節生検が行われているが,この手技を標準治療とするためには一刻も早い保険収載が必要不可欠である.●トレーサーが適応外であることが,センチネルリンパ節生検の保険収載への大きな障壁であり,公知申請によるトレーサーの薬事承認に向けて現在活動を進めている.

記述言語：日本語   出版者・発行元：Gynecologic Oncology  

Objective: This multicenter study aimed to evaluate the accuracy of the one-step nucleic acid amplification (OSNA) assay in diagnosing lymph node metastasis (LNM) in patients with cervical and endometrial cancers. Methods: Surgically removed LNs from patients with cervical and endometrial cancer were sectioned at 2-mm intervals along the short axis direction and alternately examined using the OSNA assay and conventional histopathological examination. Ultrastaging (200-μm LN sections) was performed for metastatic LNs using hematoxylin and eosin staining and immunostaining with an anti-CK19 antibody in cases where the OSNA assay and histopathological examination (performed using 2-mm LN sections) results showed discordance. Results: A total of 437 LNs from 133 patients were included; 61 patients (14%) showed metastasis by histopathological examination, with a concordance rate of 0.979 (95% confidence interval [CI]: 0.961–0.991) with the OSNA assay. The sensitivity and specificity of the OSNA assay were 0.918 (95% CI: 0.819–0.973) and 0.989 (95% CI: 0.973–0.997), respectively. Discordance between the two methods was observed in nine LNs (2.1%), and allocation bias of metastatic foci was identified as the major cause of discordance. Conclusions: The OSNA assay showed equally accurate detection of LN metastasis as the histopathological examination. We suggest that the OSNA assay may be a useful tool for the rapid intraoperative diagnosis of LN metastasis in patients with cervical and endometrial cancers.

DOI： 10.1016/j.ygyno.2022.12.016

Scopus

PubMed

記述言語：日本語   出版者・発行元：(公社)日本産科婦人科学会  

記述言語：日本語   出版者・発行元：(公社)日本産科婦人科学会  

記述言語：日本語   出版者・発行元：(株)篠原出版新社  

患者は40歳代,女性.40代前半に右乳癌,40代後半に左乳癌の診断で治療を行った.遺伝カウンセリング後,multi-gene panel検査を行ったところBRCA1 Likely Pathogenicの結果でリスク低減卵管卵巣摘出術(Risk-reducing salpingo-oophorectomy;RRSO)を希望された.Clin Varに登録されていたが,解釈については記載がなかったため,保険診療でBRCA遺伝学的検査を行ったところ,同一バリアントに対してvariant of uncertain significance;VUS(病的意義不明)の結果であった.臨床倫理委員会審査を経てRRSOを行い,病理診断で卵管に前癌病変を確認した.現在の遺伝学的検査体制で起こりうることを考察し報告する.(著者抄録)

記述言語：英語  

DOI： 10.7759/cureus.31549

PubMed

記述言語：日本語   出版者・発行元：(公社)日本婦人科腫瘍学会  

出版者・発行元：金原出版  

DOI： 10.18888/sp.0000002166

CiNii Research

記述言語：日本語   出版者・発行元：金原出版(株)  

＜文献概要＞子宮頸がんにおいて骨盤リンパ節転移の有無は重要な予後因子であり,骨盤リンパ節郭清は標準術式として施行されてきた。一方,血管・神経損傷,下肢リンパ浮腫,リンパ嚢胞,腸閉塞,などの骨盤リンパ節郭清に起因する術中・術後合併症は,患者のQOL低下につながり臨床的に問題となる。子宮頸がんに対するセンチネルリンパ節(SN)生検は,術後のリンパ浮腫やリンパ嚢胞の軽減だけでなく正確な転移診断が可能であり,近年欧米では標準治療の1つとして位置づけられている。わが国では子宮頸がんに対するSN生検を多くの施設が臨床試験として施行しているが,いまだ保険未適応であり早期の保険収載が望まれる。

記述言語：日本語   出版者・発行元：Japanese Journal of Clinical Oncology  

Objective: This preliminary study aimed to assess the detection accuracy of sentinel lymph node metastasis in cervical cancer using quantitative reverse transcriptase-polymerase chain reaction. Methods: We collected cervical cancer tissues and 70 pelvic lymph node samples from patients with cervical cancer. The quantitative reverse transcriptase-polymerase chain reaction assay was performed to investigate the expression of cytokeratin 19 mRNA in cervical cancer tissues and determine the cutoff value of cytokeratin 19 mRNA between the non-metastatic and metastatic lymph nodes. Results: The expression of cytokeratin 19 mRNA in cancer tissues was detected in all (71/71) the tumours, with a median copy number of 7.56 × 105/μl of RNA by quantitative reverse transcriptase-polymerase chain reaction. Sixteen lymph nodes were diagnosed as positive by pathological examination. The median copy numbers of cytokeratin 19 mRNA for positive and negative lymph nodes were 43.3 × 104/μl and 121.1/μl, respectively. The expression of cytokeratin 19 mRNA in pathologically positive lymph nodes was higher than that in the negative lymph nodes (P < 0.0001) by quantitative reverse transcriptase-polymerase chain reaction analysis. Using a receiver operating characteristic plot, the maximum sensitivity (100%) and specificity (94.4%) were obtained when the cutoff value was set at 1169 copies/μl. Conclusions: After setting the cutoff value at 1169 copies/μl, a quantitative reverse transcriptase-polymerase chain reaction assay using cytokeratin 19 mRNA showed high accuracy in detecting lymph node metastasis in cervical cancer. We believe that the quantitative reverse transcriptase-polymerase chain reaction assay using cytokeratin 19 mRNA may be acceptable for lymph node metastasis detection in patients with cervical cancer.

DOI： 10.1093/jjco/hyac006

Scopus

PubMed

記述言語：英語   出版者・発行元：Oxford University Press  

子宮頸癌患者のリンパ節転移検出に対し、定量的RT-PCR法の有用性について検討した。2015～2019年にかけ、鹿児島大学病院で外科治療を受けた子宮頸癌患者85例から採取した子宮頸癌組織と骨盤リンパ節試料を用いて、定量的RT-PCR法により、子宮頸癌組織中のサイトケラチン19(CK19) mRNA発現を調べた。その結果、定量的RT-PCR法により、全ての子宮頸癌組織からCK19 mRNA発現が検出され、コピー数中央値は7.56×10^5コピー/μlであった。また、病理学的検査では、16のリンパ節で転移陽性と診断され、CK19 mRNAのコピー数中央値は、転移陽性リンパ節では43.3×10^4コピー/μl、転移陰性リンパ節では121.1コピー/μlであった。なお、ROC解析では、CK19 mRNAの1169コピー/μlをカットオフ値とした場合、リンパ節転移の最大感度では100%、特異度では94.4%得られた。これらの結果から、CK19 mRNA発現を指標とした定量的RT-PCR法は、子宮頸癌患者のリンパ節転移の診断に有用と判断された。

記述言語：日本語   出版者・発行元：Journal of Gynecologic Oncology  

Objective: To evaluate the accuracy of the one-step nucleic acid amplification (OSNA) assay for the diagnosis of lymph node (LN) metastasis in uterine cancer. Methods: A total of 116 LNs from 30 patients with cervical and endometrial cancer, enrolled in this prospective study, were used. Excised LNs were cut into 4 to 6 blocks at 2 mm intervals, and nonadjacent blocks were alternately subjected to either histological examination or the OSNA assay. Results: The concordance rate between histological examination and the OSNA assay in cervical cancer and in endometrial cancer was 95.9% and 95.2%, respectively. The sensitivity, specificity, and negative predictive value of the OSNA assay were 80%, 97.7%, and 97.7% in cervical cancer, and 85.7%, 93.3%, and 98.2% in endometrial cancer, respectively. In cervical cancer, discordant results were observed in 2 out of 49 LNs (4.1%); 1 was OSNA assay-positive and histological examination-negative, and 1 was OSNA assay-negative and histological examination-positive. In endometrial cancer, discordant results were observed in 5 out of 67 LNs (7.5%); 4 were OSNA assay-positive and histological examination-negative, and 1 was OSNA assay-negative and histological examination-positive. Conclusion: The OSNA assay showed high concordance rate with histological examination, sensitivity, and specificity in uterine cancer, suggesting that it could enhance the accuracy of conventional pathological examination for the detection of LN metastasis by reducing false negative rate.

DOI： 10.3802/jgo.2022.33.e11

Scopus

PubMed

記述言語：日本語   出版者・発行元：鹿児島産科婦人科学会  

症例は63歳女性で、検診目的に近医産婦人科を受診し、経腟超音波断層法でDouglas窩に10cm大の液面形成を伴う嚢胞性腫瘍を認め、精査加療目的に当科初診となった。術前診断は右卵巣腫瘍(成熟奇形腫疑い)で、腹腔鏡補助下手術の方針とした。右付属器を摘出して迅速病理診断に提出し、成熟奇形腫の扁平上皮癌への悪性転化の診断となった。卵巣癌根治手術に移行し、単純子宮全摘出術・左付属器摘出術・大網部分切除・傍大動脈～骨盤リンパ節郭清を行った。腫瘍の一部が癒着し浸潤の可能性がある左骨盤腹膜も摘出し、最終的に肉眼的残存病変はなくR0切除をし得た。術後経過は良好であり、術後6日目に退院となった。術後化学療法としてpaclitaxelおよびcarboplatinを1コース施行した。

記述言語：日本語   出版者・発行元：鹿児島産科婦人科学会  

腹腔鏡併用による人工真皮を用いたMclndoe変法の治療経過について、4例のMayer-Rokitansky-Kuster-Hauser症候群の自験例とともに報告した。造腟術を希望しMclndoe変法を施行した19～60歳の4症例を対象に、安全性および有効性に関する後ろ向き観察研究を実施した。腟式手技に加えて腹腔鏡を併用することにより腹腔内から容易に腟腔形成の方向を決定することが可能であり、手技に伴う膀胱損傷や直腸損傷は認めなかった。全例に卵管または付属器摘出術を施行し、2例では痕跡子宮を摘出した。人工真皮は主にテルダーミスが用いられ多孔性プロテーゼに適切に縫合被覆が可能であったが、インテグラを用いた2例は浸軟しているため縫合に工夫が必要であった。今回、Mclndoe変法により安全に腟腔を形成し、プロテーゼの改良により術後の腟腔の管理を改善することができた。

記述言語：日本語   出版者・発行元：鹿児島産科婦人科学会  

症例は28歳女性で、月経不順と挙児希望を主訴に前医を受診した。経腟超音波断層法で子宮体下部に3cm大高輝度エコー領域を指摘され、組織診で類内膜癌Grade 1を認めたため当科紹介となった。傍大動脈リンパ節郭清を伴う子宮体癌手術の方針とし、当科で行っている私費臨床試験「ロボット支援子宮体癌根治術(子宮・付属器摘出+骨盤傍大動脈リンパ節郭清±大網・虫垂切除)の確立」への参加を希望され、ロボット支援での根治手術を施行した。傍大動脈リンパ節郭清時に大動脈分岐から1cmほど頭側の高さで腹部大動脈から直接右側へ出る血管を認め、同様に下腸間膜動脈から1cm尾側にも腹部大動脈から右側へ出る血管を認めた。右腎動脈の破格を疑い術中に再度造影CTを確認したところ、2本の血管は右腎に流入しており右腎動脈の破格であることが判明した。現在術後半年が経過しているが再発なく経過している。

記述言語：日本語   出版者・発行元：Abdominal Radiology  

Purpose: To examine the usefulness of machine learning to predict prognosis in cervical cancer using clinical and radiomic features of 2-deoxy-2-[¹⁸F]fluoro-D-glucose (¹⁸F-FDG) positron emission tomography/computed tomography (CT) (¹⁸F-FDG-PET/CT). Methods: This retrospective study included 50 cervical cancer patients who underwent ¹⁸F-FDG-PET/CT before treatment. Four clinical (age, histology, stage, and treatment) and 41 ¹⁸F-FDG-PET-based radiomic features were ranked and a subset of useful features for association with disease progression was selected based on decrease of the Gini impurity. Six machine learning algorithms (random forest, neural network, k-nearest neighbors, naive Bayes, logistic regression, and support vector machine) were compared using the areas under the receiver operating characteristic curve (AUC). Progression-free survival (PFS) was assessed using Cox regression analysis. Results: The five top predictors of disease progression were: stage, surface area, metabolic tumor volume, gray-level run length non-uniformity (GLRLM_RLNU), and gray-level non-uniformity for run (GLRLM_GLNU). The naive Bayes model was the best-performing classifier for predicting disease progression (AUC = 0.872, accuracy = 0.780, F1 score = 0.781, precision = 0.788, and recall = 0.780). In the naive Bayes model, 5-year PFS was significantly higher in predicted non-progression than predicted progression (80.1% vs. 9.1%, p < 0.001) and was only the independent factor for PFS in multivariate analysis (HR, 6.89; 95% CI, 1.92–24.69; p = 0.003). Conclusion: A machine learning approach based on clinical and pretreatment ¹⁸F-FDG PET-based radiomic features may be useful for predicting tumor progression in cervical cancer patients.

DOI： 10.1007/s00261-021-03350-y

Scopus

PubMed

記述言語：日本語   出版者・発行元：Japanese Journal of Clinical Oncology  

Background: We aimed to compare the detection rate of pelvic sentinel lymph node between the radio-isotope with 99m technetium (99mTc)-labeled phytate and near-infrared fluorescent imaging with indocyanine green in patients with endometrial cancer. Methods: This study included 122 patients who had undergone sentinel lymph node mapping using 99mTc and indocyanine green. In the radio-isotope method, sentinel lymph nodes were detected using uterine cervix 99mTc injections the day before surgery. Following injection, the number and locations of the sentinel lymph nodes were evaluated by lymphoscintigraphy. In addition, indocyanine green was injected into the cervix immediately before surgery. Results: The overall pelvic sentinel lymph node detection rate (at least one pelvic sentinel lymph node detected) was not significantly different between 99mTc (95.9% [117/122]) and indocyanine green (94.3% [115/122]). Similarly, the bilateral sentinel lymph node detection rate was not significantly different between 99mTc (87.7% [107/122]) and indocyanine green (79.5% [97/122]). More than two sentinel lymph nodes per unilateral pelvic lymph node were found in 12.3% (15/122) and 27% (33/122) of cases with 99mTc and indocyanine green, respectively, in the right pelvic side, and 11.5% (14/122) and 32.8% (40/122) of cases with 99mTc and indocyanine green, respectively, in the left pelvic side. indocyanine green showed that there were significantly more than two sentinel lymph nodes in either the left or right pelvic sentinel lymph nodes (P < 0.0001). There was a significant difference in the mean number of total pelvic sentinel lymph nodes between 99mTc (2.2) and indocyanine green (2.5) (P = 0.028) methods. Conclusion: Although indocyanine green is useful for sentinel lymph node identification, we believe it is better to use it in combination with 99mTc until the surgeon is accustomed to it.

DOI： 10.1093/jjco/hyab172

Scopus

PubMed

記述言語：英語   出版者・発行元：Oxford University Press  

子宮摘出術と両側卵管卵巣摘出術を受けた子宮内膜癌(EC)患者において、99mテクネシウム(99mTc)による方法とインドシアニングリーン(ICG)を用いた近赤外蛍光イメージングによる骨盤内センチネルリンパ節の検出率を後方視的に検討した。EC患者122例(年齢28～81歳)を対象とした。全例におけるセンチネルリンパ節検出率(1個以上のセンチネルリンパ節の検出)は、99mTc(95.9%、117/122例)とICG(94.3%、115/122例)で有意差はなかった。両側のセンチネルリンパ節検出率では、99mTc(87.7%、107/122例)とICG(79.5%、97/122例)の間で有意差はなかった。片側骨盤リンパ節あたり2個以上のセンチネルリンパ節は、右骨盤側で99mTcとICGによりそれぞれ12.3%(15/122例)と27%(33/122例)、左骨盤側で99mTcとICGによりそれぞれ11.5%(14/122例)と32.8%(40/122例)で確認された。ICGでは、左右いずれの骨盤リンパ節においても、2つ以上のセンチネルリンパ節が有意に多かった(p<0.0001)。総センチネルリンパ節数の平均値は、99mTc(2.2個)とICG(2.5個)で有意差があった(p=0.028)。以上より、ICGを用いた近赤外蛍光イメージングはセンチネルリンパ節の同定に有用であった。

記述言語：日本語   出版者・発行元：Pathology and Oncology Research  

It is often difficult to histologically differentiate among endometrial dedifferentiated carcinoma (DC), endometrioid carcinoma (EC), serous carcinoma (SC), and carcinosarcoma (CS) due to the presence of solid components. In this study, we aimed to categorize these carcinomas according to The Cancer Genome Atlas (TCGA) classification using a small custom-made cancer genome panel (56 genes and 17 microsatellite regions) for integrated molecular diagnosis. A total of 36 endometrial cancer cases with solid components were assessed using IHC, next-generation sequencing (NGS), and the custom-made panel. Among 19 EC cases, six were categorized as MMR-deficient (MMR-d) and eight were classified as having a nonspecific molecular profile. Three EC cases were classified as POLE mutation (POLEmut)-type, which had a very high tumor mutation burden (TMB) and low microsatellite instability (MSI). Increased TMB and MSI were observed in all three DC cases, classified as MMR-d with mutations in MLH1 and POLD1. Except for one case classified as MMR-d, all SC cases exhibited TP53 mutations and were classified as p53 mutation-type. SC cases also exhibited amplification of CCND1, CCNE1, and MYC. CS cases were classified as three TCGA types other than the POLEmut-type. The IHC results for p53 and ARID1A were almost consistent with their mutation status. NGS analysis using a small panel enables categorization of endometrial cancers with solid proliferation according to TCGA classification. As TCGA molecular classification does not consider histological findings, an integrated analytical procedure including IHC and NGS may be a practical diagnostic tool for endometrial cancers.

DOI： 10.3389/pore.2021.1610013

Scopus

PubMed

記述言語：日本語   出版者・発行元：Journal of Obstetrics and Gynaecology Research  

Objective: To determine the significance of zinc supplementation for zinc deficiency during chemotherapy for gynecologic malignancies. Methods: Twenty-eight patients suspected of zinc deficiency before chemotherapy were prospectively evaluated. Gustatory test, serum zinc, blood count, and biochemical examinations were made pre-chemotherapy at 3- and 6-week intervals. Patients with serum zinc levels <70 μg were prescribed oral zinc acetate hydrate (167.8 mg/day) for 3 weeks. The primary outcome was efficacy of zinc supplementation, the secondary outcomes were zinc deficiency rates and adverse effects of the zinc supplement. Results: Fifteen (mean serum zinc level: 67.4 ± 6.2 μg/dL) out of 28 patients were administered zinc supplementation pre-chemotherapy, and subsequent serum zinc levels reached 83.2 ± 15.3 μg/dL in 3 weeks. Factors associated with chemotherapy (vs. chemoradiation, p = 0.041) and taxane + platinum (p = 0.048) were significant risk factors for decreasing zinc levels following chemotherapy. Although patients that required zinc supplementation showed decreased serum zinc levels after chemotherapy and tended to experience taste alteration (sour: p = 0.041), zinc supplementation for zinc deficiency during chemotherapy did not alter taste perception. Conclusion: Zinc supplementation promptly increased serum levels without major complications and may prevent an alteration in taste perception.

DOI： 10.1111/jog.14996

Scopus

PubMed

記述言語：英語   出版者・発行元：John Wiley & Sons Australia, Ltd  

化学療法施行前に亜鉛欠乏が疑われた婦人科悪性腫瘍患者28例(平均57.5±13.1歳)を対象とした前向き研究を実施し、化学療法中の亜鉛欠乏に対する亜鉛補給の意義について検討した。血清中亜鉛値が70μg未満の患者に対し、酢酸亜鉛水和物(167.8mg/日)を3週間経口投与した。各時点(化学療法前、介入3週後、6週後)で味覚検査、血清中亜鉛値、血球数、生化学的検査を実施した。主要評価項目は亜鉛補給の有効性、副次評価項目は亜鉛欠乏率および亜鉛補給の副作用とした。その結果、28例中15例(平均血清中亜鉛濃度67.4±6.2μg/dL)に対し、化学療法前に亜鉛補給が行われた。3週時点での平均血清中亜鉛値は83.2±15.3μg/dLに達した。また、化学療法(対化学放射線療法、p=0.041)およびタキサン製剤+プラチナ製剤(p=0.048)が化学療法後の亜鉛値低下の有意な危険因子であった。化学療法後に亜鉛補給が行われた亜鉛欠乏患者では味覚変化を経験する傾向があったが(酸味:p=0.041)、化学療法中に亜鉛補給が行われた亜鉛欠乏患者では味覚変化は認められなかった。以上から、亜鉛補給は、大きな合併症を伴わずに速やかに血清中亜鉛値を上昇させ、味覚変化を予防する可能性が示唆された。

記述言語：日本語   出版者・発行元：Japanese Journal of Clinical Oncology  

Background: The recent improvements in anti-cancer therapy following first-line treatment can potentially impact post-progression survival. We evaluated the factors that influence post-progression survival in advanced recurrent ovarian cancer. Methods: Eighty-nine patients who underwent first-line treatment between June 2005 and December 2017 were included. The post-progression survival was defined as the difference between overall survival and initial progression-free survival. The effects of age, histology, stage, optimal surgery, secondary debulking surgery, bevacizumab administration, platinum sensitivity, and olaparib maintenance in recurrence were compared and independent risk factors were determined. Results: The median follow-up duration was 60.0 months (range: 2-181). Platinum-sensitive recurrence had longer post-progression survival than platinum-resistant (P < 0.001). Inclusion of bevacizumab in first-line treatment did not produce a significant difference in post-progression survival (P = 0.462). Secondary debulking surgery (P = 0.013), bevacizumab administration (P < 0.001), and olaparib maintenance (P = 0.001) during recurrence increased post-progression survival. In multivariate analysis, histologies other than serous or endometrioid (hazard ratio = 2.389; 95% confidence interval = 1.200-4.754; P = 0.013) and non-bevacizumab usage in recurrence (hazard ratio = 4.484; 95% confidence interval = 1.939-10.370; P < 0.001) were independently correlated with poorer prognosis. Bevacizumab administration beyond progressive disease elicited improved post-progression survival (P < 0.001). In patients receiving bevacizumab in first-line treatment, exclusion of bevacizumab in the recurrent therapy (hazard ratio = 5.507; 95% confidence interval = 2.301-12.124; P < 0.001) was independently correlated with poorer prognosis. Conclusions: The continuous use of bevacizumab beyond progressive disease improves post-progression survival suggesting its important role in first-line and recurrence treatment for ovarian cancer.

DOI： 10.1093/jjco/hyab105

Scopus

PubMed

記述言語：英語   出版者・発行元：Oxford University Press  

増悪後生存率(PPS)中央値の進行・再発卵巣癌患者において、生存期間に影響を及ぼす臨床的要因を比較し、PPSに対するベバシズマブ(Bev)治療の効果について検討した。2005年6月～2017年12月に一次治療を受けた進行・再発卵巣癌患者89例を対象とした。白金製剤感受性の再発は、白金製剤耐性の再発よりも増悪後の生存期間が長かった(p<0.001)。Bevを一次治療に含めても増悪後の生存率に有意差はなかった(p=0.462)。再発時の二次腫瘍減量手術(p=0.013)、Bev投与(p<0.001)、オラパリブ維持療法(p=0.001)により増悪後生存率が上昇した。多変量解析では、漿液性または類内膜以外の組織型(ハザード比[HR]:2.389、95%CI:1.200～4.754、p=0.013)および再発時のBev非使用(HR:4.484、95%CI:1.939～10.370、p<0.001)が予後不良と独立して相関していた。増悪後にBevを投与すると、増悪後の生存率が改善された(p<0.001)。また、一次治療でBevを投与された患者では、再発治療でのBev非使用(HR:5.507、95%CI:2.301～12.124、p<0.001)は予後不良と独立して相関していた。以上より、増悪後にBevを継続使用することにより増悪後の生存率が向上した。

記述言語：英語  

DOI： 10.2739/kurumemedj.MS662003

PubMed

記述言語：日本語   出版者・発行元：(公社)日本婦人科腫瘍学会  

記述言語：日本語   出版者・発行元：(公社)日本婦人科腫瘍学会  

記述言語：日本語   出版者・発行元：(株)メジカルビュー社  

記述言語：日本語   出版者・発行元：International Journal of Clinical Oncology  

Background: Sentinel lymph node (SN) biopsy is essential for evaluating survival and minimal treatment-related morbidity associated with cervical, endometrial, and vulvar cancer in Japan. As such, our aim in this study was to evaluate the current practice pattern of using SN biopsy for cervical, endometrial, and vulvar cancer in Japan. Methods: We deployed a 47-question survey on the use of SN biopsy for gynecological cancers to 216 gynecological oncology training facilities. The survey included information on the use of SN biopsy for uterine (cervical and endometrial) and vulvar cancers; details on the type, timing, and concentration of tracers used; surgical approach used for SN biopsy; method of biopsy and pathological examination; and facilities’ experience with clinical research on SN biopsy. Results: The response rate was 84% (181/216), with 40 facilities (22%) having experience in SN biopsy for gynecological cancers, 34 (85%) for uterine cancers, and 15 (37%) for vulvar cancers. Radioisotope, indocyanine green (ICG), and blue dyes were available for the detection of uterine cancers in 21 (52%), 25 (62%), and 19 (48%) facilities and for vulvar cancers in 9 (22%), 3 (7%), and 11 (27%) facilities, respectively. Thirty-four facilities (85%) used intraoperative frozen section procedure for diagnosis when possible, with 24 (71%) of these facilities using 2-mm specimen cuts. Diagnosis included pathological examination (85%), immunostaining (57%), and one-step nucleic acid amplification (5%). Conclusion: Increasing research evidence, providing insurance coverage for radioisotope tracers, and increasing the availability of training are expected to increase the use of SN biopsy in Japan.

DOI： 10.1007/s10147-021-01862-7

Scopus

PubMed

記述言語：英語   出版者・発行元：シュプリンガー・ジャパン(株)  

日本国内で施行されている子宮頸癌、子宮内膜癌、外陰癌に対するセンチネルリンパ節(SN)生検実施がどのように行われているか、実地診療の実態を調査した。婦人科癌へのSN生検施行について、日本婦人科腫瘍学会指定修練施設216施設に対し、47項目で構成された質問紙調査を行った。なお、質問項目には子宮(子宮頸部と子宮内膜)癌と外陰癌に対するSN生検の適用、種類や時期、使用する放射性トレーサの放射能濃度、SN生検に使用した外科的アプローチ法、生検法と病理学的検査、SN生検に関連した臨床研究による修練施設での診療経験等が含められた。その結果、回答率は84%(216施設中181施設)得られ、婦人科癌に対しSN生検の診療経験が認められた施設数は40施設で、子宮癌では34施設、外陰癌では15施設で施行されており、癌検出で用いられる放射性同位体、インドシアニングリーン(ICG)、青色色素に関しては、子宮癌では各々21施設、25施設、19施設、外陰癌では各々9施設、3施設、11施設で、34施設では可能な場合には、診断に術中凍結切片法を行い、うち24施設が2mm切片試料で実施されていた。なお、診断には85%が病理学検的査を施行し、57%が免疫染色、5%がワンステップ核酸増幅で使用されていた。今回の調査結果から、国内でSN生検の使用を増加させるには、エビデンスを充実させ、同位体トレーサー使用を保険適用とし、訓練機会を増やすことが肝要と考えられた。

記述言語：日本語   出版者・発行元：Gynecology and Minimally Invasive Therapy  

Cervical elongation in patients with pelvic organ prolapse (POP), who previously underwent laparoscopic sacrocolpopexy (LSC), is not fully understood. We report a case of a second surgery for endometrial cancer complicated with POP recurrence, which seemed to be related to cervical elongation following LSC. A 65-year-old woman was referred for invasive treatment following LSC. Although preoperative endometrial cytology was negative, the resected uterine specimen revealed endometrioid carcinoma. The patient also had complications of cervical prolapse with cystocele Stage III. Repeat surgery was performed with a trachelectomy, anterior-posterior colporrhaphy, and vaginal apex suspension. Mesh had been adequately sutured to the upper cervix in the previous surgery, and the resected cervix was elongated up to 9 cm. Cervical elongation may be correlated with the inaccurate preoperative endometrial examination, and it may also promote POP recurrence leading to a poorly supported pelvic floor. We suggest that cervical elongation should be identified before POP surgery.

DOI： 10.4103/GMIT.GMIT_114_19

Scopus

PubMed

記述言語：日本語   出版者・発行元：鹿児島産科婦人科学会  

症例は73歳女性で、原発性卵巣癌術後に初回のパクリタキセル(PTX)+カルボプラチン療法を行った。アレルギー歴に関する特記事項はなく、入院の上でデキサメタゾン静注、抗ヒスタミン剤内服等の前投与下にPTXを開始したが、投与開始3分後に気分不良、嘔気を訴え、軽症から中等症の過敏症反応(HSR)が疑われた。しかし、アレルギー反応に特徴的な蕁麻疹や皮膚紅潮、気管支喘息様症状は認めず、ステロイドやアドレナリンによる初期治療に抵抗性であり、PTX中止後も進行性に意識障害をきたして呼吸停止、心停止を確認した。ICU搬入後に循環作動薬への反応が回復し、バイタルサインが正常化するも蘇生後脳症から多臓器不全をきたして永眠された。PTXはいつでもHSRが起こり得る薬剤であり、事前に患者・家族への十分な説明を行うとともに、適切な対応の準備、厳重な監視下で使用することが大切である。

記述言語：日本語   出版者・発行元：鹿児島産科婦人科学会  

症例は46歳2妊2産で、左下腹部腫瘤感を主訴とした。子宮漿膜下筋腫、左卵巣子宮内膜症性嚢胞の精査加療目的で初診し、子宮腟部と子宮内膜の細胞診、組織診で悪性所見は認めなかった。子宮漿膜下筋腫、左卵巣子宮内膜症性嚢胞の術前診断で腹腔鏡下単純子宮全摘術、左付属器切除術、右卵管切除術、腹腔内洗浄細胞診を行い、術後の病理組織所見では子宮内膜や左卵巣腫瘍に腺癌成分はみられなかったが、核出された筋腫核内に明細胞癌成分を確認したほか、核出部付近の子宮筋層に異所性子宮内膜腺と間質を認め、子宮筋腫内に存在した異所性子宮内膜から明細胞癌が発生したと考えられた。後日、腹腔鏡下右卵巣摘出術、大網部分切除術、虫垂切除術、後腹膜リンパ節郭清を行い、最終病理学的診断は明細胞癌、手術進行期IB期(pT1bN0M0)であった。術後化学療法を6コース行い、現在まで明らかな再発なく経過している。

記述言語：日本語   出版者・発行元：(公社)日本産科婦人科学会  

記述言語：日本語   出版者・発行元：(公社)日本産科婦人科学会  

記述言語：日本語   出版者・発行元：Journal of Obstetrics and Gynecology of India  

Objective: This study aimed to examine the associations of cone margin and human papillomavirus (HPV) status after conization with cytological abnormalities and disease recurrence in patients with cervical intraepithelial neoplasia grade 3 (CIN3). Methods: This is a retrospective study of 366 women with CIN3 who underwent conization at Kagoshima University Hospital between 2004 and 2017. Conization was performed using an ultrasonic scalpel. The polymerase chain reaction for detecting HPV genotypes was performed using fresh cervical cell samples. We examined the associations of margin status and HPV status after conization with cytological abnormalities and recurrence. Results: Among 224 women with CIN3, 193 (86.2%) underwent HPV genotype testing before conization. The HPV-positive rate was 84.9%. The most common HPV genotypes before conization were HPV 16, 31, 58, 52, 18, 35, and 33. In 191 patients, the uterus was preserved after conization. Sixteen patients had pathologically positive margins, 165 had negative margins, and 10 had unclear margins. There was no significant difference in abnormal cytology and recurrence rate after conization between the three groups. Five patients with positive margins and abnormal cytology during follow-ups were HPV16- or HPV58-positive in the preoperative HPV testing. Of the 191 women, 91 (47.6%) underwent pre- and postoperative HPV genotype testing, among whom 14 (15.4%) were HPV-positive after conization. No significant difference in abnormal cytology based on HPV status after conization was found. The recurrence rate tended to be higher in HPV-positive patients than in HPV-negative patients after conization (21.4% vs. 1.3%, p < 0.05). Three patients with HPV positivity after conization and recurrence during follow-up were HPV16- or HPV58-positive. Conclusions: HPV positivity after conization for CIN3 was associated with a high recurrence rate, especially in HPV16- and HPV58-positive patients. HPV58 has not received much attention thus far, but abnormalities in cytology and recurrence may be as likely as those associated with HPV16. Thus, a careful follow-up in such patients is recommended.

DOI： 10.1007/s13224-020-01368-8

Scopus

PubMed

記述言語：日本語   出版者・発行元：(公社)日本婦人科腫瘍学会  

記述言語：日本語   出版者・発行元：Molecular Imaging and Biology  

Purpose: To examine the prognostic significance of pretreatment 2-deoxy-2-[¹⁸F]fluoro-d-glucose ([¹⁸F]-FDG) positron emission tomography (PET)-based radiomic features using a machine learning approach in patients with endometrial cancers. Procedures: Included in this retrospective study were 53 patients with endometrial cancers who underwent [¹⁸F]-FDG PET/X-ray computed tomography (CT) before treatment. Since two different PET scanners were used, post-reconstruction harmonization was performed for all PET parameters using the ComBat harmonization method. Four clinical (age, histological type, stage, and treatment method) and 40 [¹⁸F]-FDG PET-based radiomic features were ranked, and a subset of useful features was selected based on the decrease in the Gini impurity in terms of associations with disease progression. The machine learning algorithms (random forest, neural network, k-nearest neighbors (kNN), naive Bayes, logistic regression, and support vector machine) were compared using the areas under the receiver operating characteristic curve (AUC) and validated by the random sampling method. Progression-free survival (PFS) and overall survival (OS) were assessed by the Cox regression analysis. Results: The five best predictors of disease progression were coarseness, gray-level run length nonuniformity, stage, treatment method, and gray-level zone length nonuniformity. The kNN model obtained the best performance classifier for predicting the disease progression (AUC =0.890, accuracy =0.849, F1 score =0.848, precision =0.857, and recall =0.849). Coarseness which was the first ranked radiomic feature was selected for survival analyses, and only coarseness remained as a significant and independent factor for both PFS (hazard ratios (HR), 0.65; 95 % confidence interval [CI], 0.49–0.86; p=0.003) and OS (HR, 0.52; 95 % CI, 0.36–0.76; p<0.001) at multivariate Cox regression analysis. Conclusions: [¹⁸F]-FDG PET-based radiomic analysis using a machine learning approach may be useful for predicting tumor progression and prognosis in patients with endometrial cancers.

DOI： 10.1007/s11307-021-01599-9

Scopus

PubMed

記述言語：日本語   出版者・発行元：Japanese Journal of Clinical Oncology  

Objective To evaluate the feasibility, safety and surgical outcomes of laparoscopic surgery for the treatment of low-risk endometrial cancer. Methods Of 155 patients with low-risk endometrial cancer, who were included in this retrospective study between May 2008 and March 2017, 82 and 73 underwent laparoscopic and open surgery, respectively. Clinicopathological and surgical data, recurrence-free survival and overall survival were analyzed. Results No statistically significant differences in median age, final pathological type, International Federation of Gynecology and Obstetrics stage and lymphovascular space involvement were observed between the laparoscopic and open surgery groups. No procedure in the laparoscopic surgery group was converted to open surgery. The median follow-up period was 60 months, with oncologic recurrence identified in three cases (one lung carcinoma and two pelvic cavity carcinomas) in the laparoscopic surgery group. There was no significant between-group difference in 5-year recurrence-free survival (laparoscopic surgery group: 96.3%, open surgery group: 92.6%) and overall survival (laparoscopic surgery group: 100%, open surgery group: 95.4%). Conclusions Laparoscopic surgery is a feasible and safe treatment for endometrial cancer and should be considered as a standard treatment option for low-risk endometrial cancer.

DOI： 10.1093/JJCO/HYAA116

Scopus

PubMed

記述言語：日本語   出版者・発行元：Japanese Journal of Clinical Oncology  

Background: Sentinel node navigation surgery (SNNS) has been frequently used in early cervical cancer. However, the incidence and potential reduction of lymphatic complications following the removal of the sentinel lymph node remain unknown. Thus, this study aimed to evaluate the occurrence of lymphatic complications post sentinel node navigation surgery in patients with early cervical cancer. Methods: A total of 167 patients, including 70 and 97 patients who had undergone SNNS and pelvic lymphadenectomy (PLA), respectively, were enrolled in this study. We compared the lymphatic complications (lower extremity lymphedema and pelvic lymphocele) between the SNNS and PLA groups. Results: The median number of sentinel lymph nodes removed was 2 (range: 1-14). Among the 70 patients in the SNNS group, there were 0 (0%) and 3 (4.3%) occurrences of lower extremity lymphedema and pelvic lymphocele, respectively. The occurrences of lower extremity lymphedema and pelvic lymphocele were significantly lower in the SNNS group than in the PLA group, despite circumflex iliac node removal. Conclusions: The occurrence of lymphatic complications (lower extremity lymphedema and pelvic lymphocele)was significantly lower in the SNNS group than in the PLA group.We found that SNNS, and not PLA, was the best treatment option for preventing the development of lower extremity lymphedema and pelvic lymphocele, despite circumflex iliac node preservation.

DOI： 10.1093/JJCO/HYAA001

Scopus

PubMed

出版者・発行元：Oxford University Press  

出版者・発行元：BMC Medical Genomics  

DOI： 10.1186/s12920-020-00753-6

Scopus

PubMed

出版者・発行元：International journal of gynecological cancer : official journal of the International Gynecological Cancer Society  

DOI： 10.1136/ijgc-2019-001154

Scopus

PubMed

出版者・発行元：Taiwanese Journal of Obstetrics and Gynecology  

DOI： 10.1016/j.tjog.2020.03.015

Scopus

PubMed

出版者・発行元：Oxford University Press  

早期子宮頸癌の患者に対しセンチネルリンパ節ナビゲーション手術(SNNS)を施行した時のリンパ系合併症を骨盤リンパ節郭清術(PLA)施行の場合と比較評価した。病期IA2〜IIBの子宮頸癌に罹患し、2007年4月〜2017年8月に当大学病院にて子宮・子宮頸部の広汎・準広汎摘出術を受けたが、その際にSNNSを施行されていた患者70名(年齢20〜74歳)とPLA施行の97名(22〜74歳)を後方視的に調査した。リンパ系合併症のうち下肢のリンパ浮腫の発生率はSNNS群とPLA群でそれぞれ0%と13.4%、骨盤内リンパ嚢腫は4.3%と18.6%であった。いずれの合併症についても両群の発生率には有意な差が認められた。腸骨回旋リンパ節の除去率はSNNS群で0%、PLA群で40.2%とPLA群の方が有意に高かったにも関わらず、前記した通り骨盤内リンパ嚢腫の発生率はSNNS群の方が有意に低かった。PLAに対しSNNSのリンパ系合併症発生率は有意に低いことが明らかになった。よってリンパ系合併症予防の観点から判断すると、SNNSでは腸骨回旋リンパ節が温存されるにも関わらず、それでもPLAではなくSNNSが最適な治療選択肢となると結論された。

出版者・発行元：鹿児島産科婦人科学会  

症例は47歳1妊1産で、卵巣癌の初回治療として卵巣癌根治術、Conventional paclitaxel、Carbopulatin(TC)療法およびBevacizumab(Bev)療法とBev維持療法を行った。その後は経過観察されていたが、TC療法終了後4年1ヵ月に多発骨盤内再発を認めた。内診では腟断端に鶏卵大の腫瘤を触知し、腟鏡診でも再発腫瘤が露出しており、針生検よりプラチナ感受性再発卵巣癌と診断してTC+Bev療法を開始したが、1コース目のday7に便臭を伴う褐色帯下と下腹部の圧痛が出現し、造影CT、小腸造影検査にて回腸腟瘻と診断された。腹腔鏡下回腸上行結腸吻合術を行い、術後はTC療法6コースを完遂してComplete Responseが得られた。

出版者・発行元：鹿児島産科婦人科学会  

子宮体癌ロボット手術症例を後方視的に検討し、BMI 35以上の高度肥満症例に対する有用性・安全性を検証した。単純子宮全摘、両側付属器摘出、センチネルリンパ節生検を行った子宮体癌35例(高度肥満群7例、対照群28例)の手術時間、コンソール時間、出血量、術後在院日数、手術合併症を比較した。その結果、手術時間、コンソール時間、出血量、在院日数に有意な群間差は認めなかった。また、手術合併症は対照群の7例で術後感染3例、腟断端離開、大腿神経障害、尿管狭窄、腸閉塞各1例を認めたが、高度肥満群ではClavien-Dindo分類のグレード2以上の合併症は認めなかった。子宮筋腫の有無や子宮の大きさなど手術に影響を与える因子を検討する必要があるが、ロボット手術では高度肥満症例においてもスムーズな骨盤深部の手術操作が可能であることが示された。

出版者・発行元：鹿児島産科婦人科学会  

2018年5月から2019年11月にオラパリブを投与した再発卵巣癌16例(年齢中央値57歳、投与期間中央値134日)の患者背景と有害事象について後方視的に検討した。組織型は漿液性癌12例、明細胞癌3例、癌肉腫1例で、進行期はIIIC期が10例と最も多く、オラパリブ投与前の治療効果はCR(完全寛解)1例、PR(部分奏功)15例であった。オラパリブの治療効果はPR 1例、SD 7例で中止例はPD(増悪)による6例と副作用による2例であり、多く認められた副作用は嘔気(50%)、貧血(50%)、倦怠感(37.5%)であった。オラパリブの維持療法によりQOLを保ちながらプラチナフリー期間を延長し、さらに一部の症例ではPR、CRが得られる可能性が示された。

出版者・発行元：鹿児島産科婦人科学会  

症例は46歳の経産婦で、5年前から不正出血がみられ、38℃を超える発熱があったため来院した。白血球数、血小板数、C反応性蛋白質の上昇とヘモグロビン値の低下が認められた。子宮頸部のPapanicolaou生検で、印環細胞癌(SRCC)様腫瘍細胞と非定形扁平上皮細胞が存在することが明らかになった。子宮頸部腫瘍のパンチ生検により、粘液性SRCCとHPV18型感染が認められた。根治的子宮摘出術と両側付属器切除および腹腔リンパ節郭清を行った。各種検査の結果、最終的に子宮頸部のSRCCと扁平上皮癌の衝突癌(pT1b2N0M0)と診断した。次世代シーケンシングパネルを用いて生殖細胞変異の同定を試みたところ、両病変ともFLT3、BRCA2、R1遺伝子のChr13にヘテロ接合性消失が明らかになった。パクリタキセルとカルボプラチンによる術後化学療法を6コース行った。18ヵ月間の経過観察中、疾患の兆候は認められていない。

出版者・発行元：鹿児島大学医学会  

目的:皮膚にはエストロゲン(E)レセプターが存在し、Eが複数の細胞に作用しヒアルロン酸などの生成を促進し、潤いや張りを与える。肌の老化(菲薄化、乾燥、皴の増加、弾力性の低下)には加齢、放射線療法、抗癌剤投与などが関与するが、閉経や外科的去勢でも起こる。しかし、低E状態による肌の老化はあまり研究されていない。我々はBioelectrical Impedance Analysis(BIA)で肌年齢、肌の健康状態の客観的評価が可能であることに着目し、E依存性疾患、外科的去勢および抗がん剤の肌年齢に及ぼす影響について検討した。方法:2016年7月から2018年5月までに当科を受診した患者68例を対象にした。Informed consentの後、肌年齢、肌加齢度(肌年齢-暦年齢)をWellup社製の肌年齢測定器(Well-Beauty、BIA法)で測定した。(1)有経女性でE依存性疾患患者(主に子宮筋腫や子宮体癌、n=19)とE非依存性疾患患者(主に子宮頸癌、n=38)の肌年齢や肌加齢度を比較した。(2)有経女性で外科的去勢(n=15)による肌年齢、肌加齢度の推移を卵巣温存群(n=11)と比較した。(3)閉経女性で婦人科悪性腫瘍の標準手術(含:卵巣摘出術)と化学療法を受けた患者(n=6)と標準手術のみを受けた患者(対照、n=5)で肌年齢、肌加齢度の推移を比較した。有意差検定はStudent t-test、χ2検定で適宜行った。結果:1)E依存性疾患患者ではE非依存性疾患患者に比較して肌が有意に若かった(肌加齢度:-1.0±1.4歳vs.+2.5±0.6歳、p<0.01)。2)去勢後6ヵ月で肌年齢は有意に悪化したが、卵巣温存群では変化しなかった(肌加齢度の推移:+3.5±1.4歳vs.-0.2±0.8歳、p<0.05)。3)化学療法群の化学療法終了12ヵ月後の肌年齢は、対照に比較して有意に悪化した(肌加齢度の推移:+10.5±3.3歳vs.-3.8±3.4歳、p<0.05)。化学療法により、肌年齢が5歳以上若い女性の割合も有意に減少した(5/6から1/6、p<0.05)。結論:E依存性疾患患者では肌年齢が若く、外科的去勢による低E状態は肌年齢にも悪い影響を及ぼす。一方、卵巣温存群では肌年齢は悪化しなかったため、有経期女性の予防的卵巣摘出術には慎重であるべきである。また、化学療法はより高度に肌年齢を悪化させることが判明したため、治療中のケアは重要である。(著者抄録)

機関リポジトリURL

出版者・発行元：Cancer Reports  

DOI： 10.1002/cnr2.1200

Scopus

PubMed

出版者・発行元：Journal of Obstetrics and Gynaecology Research  

DOI： 10.1111/jog.13985

Scopus

PubMed

出版者・発行元：John Wiley & Sons Australia, Ltd  

右子宮付属器切除術後に腹膜播種が合併した再発性の輪状細管を伴う性索腫瘍(SCTAT)を有する44歳女性症例について検討した。腫瘍が広範囲に浸潤していたため、完全な外科的切除はできなかった。悪性になる可能性を考慮し、術後化学療法としてbleomycin、etoposide、cisplatin(BEP)の併用を選択した。BEPレジメンを完了した後に達成できたのは部分奏効であった。Docetaxelとcarboplatin+bevacizumabによる化学療法を3コース行った。併用化学療法後のPET-CTスキャンにて完全奏効が確認され、bevacizumab投与を継続中では再発はなく、合併症からの重大な有害作用もなかった。

出版者・発行元：Oxford University Press  

早期子宮内膜癌の治療における腹腔鏡下手術の学習曲線を判定し、手術成績を報告した。2013年5月〜2017年3月に当科で腹腔鏡下手術を施行した患者82例(中央値55歳)の診療録を後ろ向きに調査した。骨盤リンパ節郭清を含む腹腔鏡下手術は、全患者に対して同じ手技と器具を用いて行った。手術手技の学習曲線(手術時間、リンパ節郭清数、術中失血量)を解析した。82例を手術日に基づいて第1群(症例1〜20)、第2群(症例21〜40)、第3群(症例41〜60)、第4群(症例61〜82)に分けた。失血量は第1群が65.3±62.3mL、第4群が15.9±19.5mLで、有意な減少が認められた。ただし、リンパ節郭清数と入院期間は学習による影響がみられなかった。以上から、手術時間と失血量は、外科医が経験を積むことで有意に短縮・減少したが、リンパ節郭清数と入院期間には学習の影響がみられないことが示された。

出版者・発行元：Japanese Journal of Clinical Oncology  

DOI： 10.1093/jjco/hyz027

Scopus

PubMed

出版者・発行元：Oncology (Switzerland)  

DOI： 10.1159/000493485

Scopus

PubMed

出版者・発行元：鹿児島産科婦人科学会  

2012年6月〜2017年2月までの期間内に、婦人科悪性腫瘍のためタキサン系抗腫瘍剤および白金製剤による化学療法が施行された患者のうち、化学療法誘発性末梢神経障害を呈した患者に対し、デュロキセチンおよびプレガバリン投与を行い、治療効果を比較した。プレガバリン投与を受けた25例(プレガバリン群)とデュロキセチン投与を受けた54例(デュロキセチン群)に分け、各薬剤の効能を評価し、NCI-CTCAE(version 4.0)に準拠した等級付けにより、等級が改善された患者を応答者、改善無し/安定患者を非応答者とした。その結果、両群のベースライン特性はほぼ同等であったが、プレガバリン群では25例中10例(40%)に、デュロキセチン群では54例中37例(69%)において、化学療法誘発性末梢神経障害の軽減が認められた。また、2等級患者のうち、プレガバリン群では19例中5例(26%)に、デュロキセチン群では37例中20例(54%)に等級低下が認められ、化学療法誘発性末梢神経障害に対し、デュロキセチンはプレガバリンと比較し、有意に高い治療応答率が示された。以上の治療成績から、婦人科悪性腫瘍でのタキサン+白金製剤による重度の末梢神経障害に対し、デュロキセチン投与は有用性が高いと判断された。

出版者・発行元：鹿児島産科婦人科学会  

33歳(未妊)。不正性器出血を主訴に、精査の結果、子宮頸癌IB1期と診断された。妊孕性温存を強く希望したため、術前化学療法後に摘出術を行う方針とした。本症例では術前化学療法としてTC療法(paclitaxel+carboplatin)を2コース行ったところ、著明な腫瘍縮小を認めた。以後、ART(腹式広汎子宮頸部摘出術)および骨盤リンパ節郭清術を施行し、術後はTC療法を4コース追加した。その結果、最終化学療法から5ヵ月経過現在、再発はみられていない。

出版者・発行元：鹿児島産科婦人科学会  

過去5年間に当科でベバシズマブ(Bev)投与を行った88例について検討した。内訳は卵巣癌が65例、子宮頸癌が23例であった。卵巣癌でのBev投与の傾向としては、主にIII-IV期で投与されており、I-II期で投与されている症例の理由としては高リスク組織型である明細胞癌のためであった。当科でのIII-IV期のMedian PFSは21ヵ月、3年生存率は80%であった。子宮頸癌については進行または再発例で投与され、主要評価項目のOSは、Bev投与群で化学療法単独群に比べ3.5ヵ月の延長が認められた。全体の12例は副作用によりBev投与が中止となっていたが、内訳では腎障害に伴う中止が8例と最も多かった。

出版者・発行元：Japanese Journal of Clinical Oncology  

DOI： 10.1093/jjco/hyy151

Scopus

PubMed

出版者・発行元：International Journal of Gynecology and Obstetrics  

DOI： 10.1002/ijgo.12651

Scopus

PubMed

出版者・発行元：Oxford University Press  

子宮頸癌患者169例(年齢中央値46歳)を対象に、骨盤内リンパ節郭清術後のリンパ系合併症の発症率を後ろ向きに調査した。リンパ系合併症として、下肢リンパ浮腫発症(LEL)と骨盤内リンパ嚢腫(PL)を評価した。BMI中央値は21.7kg/m2で、病理所見は扁平上皮癌98例、腺癌47例、腺扁平上皮癌14例、その他10例、臨床進行期分類FIGOステージは1A2が3例、1B1が59例、1B2が39例、2Aが11例、2Bが57例であった。術式は開腹術166例、腹腔鏡術2例、ロボット支援術1例であった。摘出リンパ節数中央値は27個であった。術後補助療法は化学療法39例、放射線療法81例であった。LELは28例(片側性23例、両側性5例)であった。術後からLEL発症までの期間中央値は6ヵ月であった。LELステージは0が141例、Iが13例、IIが10例、IIIが5例であった。多変量解析から摘出リンパ節数と回旋腸骨リンパ節の摘出がLELのリスク因子であった。PL発症は32例であった。術後からPL発症までの期間中央値は3ヵ月で、グレード1は25例、2は3例、3は4例であった。PLのリスク因子は認められなかった。

出版者・発行元：Japanese Journal of Clinical Oncology  

DOI： 10.1093/jjco/hyy113

Scopus

PubMed

出版者・発行元：Gynecology and Minimally Invasive Therapy  

DOI： 10.4103/GMIT.GMIT_34_18

Scopus

PubMed

出版者・発行元：Oxford University Press  

子宮頸癌患者における放射線療法時の止血治療を要する腫瘍出血の臨床的影響を調査した。また、放射線療法での腫瘍出血による貧血または輸血との相関を後ろ向きに調査した。2施設で子宮頸癌の根治的放射線療法を受けた患者196例(年齢中央値62.8歳)を対象とした。追跡期間中央値は39.6ヵ月であった。FIGO分類ではStage III患者が最も多かった(49%)。リンパ節腫脹は骨盤リンパ節のみが40例、大動脈周囲リンパ節のみが2例、骨盤リンパ節と大動脈周囲リンパ節が21例であった。外照射療法終了が全例、洞内近接照射療法終了困難は29例であった。放射線療法中の大出血によって治療を中止または1週間以上延期した症例はなかった。出血群(49例)と非出血群(147例)に分けたところ、無増悪生存期間と全生存期間は出血群で有意に短かった。出血群で貧血34例(69%)であった。全出血96例のうち貧血は35%であった。多変量解析の結果、放射線療法中の出血の独立因子はFIGOステージ、腫瘍径、出血で、無増悪生存期間期間の独立因子は貧血であった。輸血は出血群および貧血患者の無増悪生存期間を改善しなかった。

出版者・発行元：Taiwanese Journal of Obstetrics and Gynecology  

DOI： 10.1016/j.tjog.2018.04.032

Scopus

PubMed

出版者・発行元：Journal of Laparoendoscopic and Advanced Surgical Techniques  

DOI： 10.1089/lap.2017.0550

Scopus

PubMed

出版者・発行元：John Wiley & Sons Australia, Ltd  

症例は37歳女性で、急性腹痛のため来院し、婦人科検査で多発性子宮筋腫と有痛性右腟膨隆を認めた。経腟超音波検査では嚢胞性腫瘤および縦方向の腟中隔に隠れた右側子宮頸部が示された。これらの所見からobstructed hemivagina and ipsilateral renal anomaly(OHVIRA)症候群に起因する腟膿瘤が疑われた。全身状態は1時間で徐々に悪化し、敗血症性ショックを呈して集中治療室に入院した。臨床検査値により播種性血管内凝固(DIC)および多臓器不全を認め、集中治療および膿瘍の経腟穿刺ドレナージを実施した。全身状態は徐々に改善し、入院第6日にICUから一般病棟に移り、入院第11日に退院した。退院前のMRIでは多発性子宮筋腫、右側ミュラー管異常を伴うOHVIRA症候群を認めた。急性敗血症エピソードの2ヵ月後に子宮摘出を実施し腟中隔も同時に除去した。総子宮重量は810gであった。片側腟閉鎖を伴う中隔子宮と診断し、術後経過は良好であった。

出版者・発行元：Journal of Obstetrics and Gynaecology Research  

DOI： 10.1111/jog.13656

Scopus

PubMed

出版者・発行元：鹿児島産科婦人科学会  

1997年1月〜2010年9月に当施設で婦人科悪性腫瘍と診断し、一次治療として手術を施行した患者362例を対象に、皮下ドレーン留置が皮膚吻合後の創離開にどのような影響を及ぼすかを後向きに評価した。皮下ドレーン留置患者(留置群)は131例(平均56.2±14.0歳)、非留置患者(非留置群)は231例(平均54.0±14.6歳)であった。創離開の全発生率は留置群3/131例、非留置群18/231例であった(p=0.031)。創離開率はBMI(p=0.007)、疾患進行度(p=0.002)、手術時間(p=0.013)と正の相関が認められた。多重ロジスティック回帰分析により、肥満、疾患ステージ進行、長い手術時間を創離開の独立したリスクとして特定した。肥満患者では、非留置群の方が創離開率は高かった。以上より、婦人科悪性腫瘍手術時の皮下ドレーン留置は、皮膚吻合後の創離開率を低下させることが示された。

出版者・発行元：鹿児島産科婦人科学会  

2015年12月から子宮頸癌に対する腹腔鏡下広汎子宮全摘術(TLRH)が先進医療に認定され、当科でも早期子宮頸癌に対してTLRHを導入し先進医療承認を得たので、同手術の有用性と安全性を評価し報告した。臨床試験として行った3症例と施設承認後に先進医療として治療を行った7症例(年齢30〜52、平均46歳)を対象に、手術時間、出血量、合併症、術後退院期間などについて検討した。その結果、10症例の手術時間は207〜418分(平均306分)、術中出血量は5〜570ml(平均155ml)であった。術中・術後合併症は認めず、術後退院期間は全例7日目であった。

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

出版者・発行元：Journal of Palliative Medicine  

DOI： 10.1089/jpm.2019.0393

Scopus

PubMed

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：英語  

記述言語：英語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：英語  

記述言語：日本語  

記述言語：英語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：英語  

記述言語：英語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：英語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：英語  

記述言語：英語  

記述言語：日本語  

記述言語：英語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：英語  

記述言語：英語  

記述言語：日本語  

記述言語：日本語  

記述言語：英語  

記述言語：日本語  

記述言語：英語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語